Concordance of judgement: A tool to foster the development of professionalism in dentistry.

INTRODUCTION: Developing professionalism notably involves learning how to make professional judgements in ambiguous situations. The Concordance of Judgement Test (CJT) is a learning tool that was proposed to develop professionalism competencies, but it was never performed in dentistry or used with a synchronous methodology. The present study evaluated the feasibility of the use of CJT in the context of dental education, to foster professionalism and stimulate reflexivity and discussion. MATERIALS AND METHODS: After different steps of optimization, a questionnaire presenting 12 vignettes was submitted to 33 Canadian students. Second, after an additional optimization, a questionnaire of 7 vignettes was submitted to 87 French students. An immediate educational feedback was proposed after each vignette to promote reflexivity and discussions during the experience. RESULTS: The overall experience of the students was reported as good, thanks to the feedback of real-life situations. This promoted reflexivity and stimulated discussion between students and educators regarding professionalism issues. The students considered CJT as a relevant and well-adapted tool, and reported positive feelings regarding the inter-university aspect of the activity. The mean score of the panel members was close to 80/100 and the mean score of the students was 5 to 10 points lower, which is in agreement with docimological performance. CONCLUSION: The results suggested that the use of CJT in a synchronous way was a feasible and relevant tool to motivate the students to improve their professionalism, and to stimulate their reflexivity and discussion. The students reported positive experience with CJT, and we believe that this tool can be integrated in the dental curriculum.

Script concordance tests: A call for action in dental education.

The Script Concordance Test (SCT) is an educational tool that aims to assess the ability to interpret medical information under conditions of uncertainty. It is widely used and validated in health education, but almost unknown in dentistry. Based on authentic clinical problem-solving situations, it allows to assess clinical reasoning that experienced health workers develop over the years. A specific scoring system, dedicated to SCT, considers the variability of responses of practitioners in the same clinical situations. Finally, the scores generated by SCT reflect the respondents' ability to interpret clinical data compared to experienced clinicians. This article aims to familiarise the dental educators' community with SCT construction, optimisation and its possible applications.

Two-eyed seeing of the integration of oral health in primary health care in Indigenous populations: a scoping review.

BACKGROUND: Indigenous people experience significant poor oral health outcomes and poorer access to oral health care in comparison to the general population. The integration of oral health care with primary health care has been highlighted to be effective in addressing these oral health disparities. Scoping studies are an increasingly popular approach to reviewing health research evidence. Two-eyed seeing is an approach for both Western and Indigenous knowledge to come together to aid understanding and solve problems. Thus, the two-eyed seeing theoretical framework advocates viewing the world with one eye focused on Indigenous knowledge and the other eye on Western knowledge. This scoping review was conducted to systematically map the available integrated primary oral health care programs and their outcomes in these communities using the two-eyed seeing concept. METHODS: This scoping review followed Arksey and O'Malley's five-stage framework and its methodological advancement by Levac et al. A literature search with defined eligibility criteria was performed via several electronic databases, non-indexed Indigenous journals, Indigenous health organizational websites, and grey literature. The charted data was classified, analyzed, and reported using numeral summary and qualitative content analysis. The two-eyed seeing concept guided the interpretation and synthesis of the evidence on approaches and outcomes. RESULTS: A total of 29 publications describing 30 programs conducted in Australia and North America from 1972 to 2019 were included in the final analysis. The following four program categories emerged from the analysis: oral health promotion and prevention programs (n = 13), comprehensive dental services (n = 13), fly in, fly out dental services (n = 3), and teledentistry (n = 1). Biomedical approaches for integrated primary oral health care were leadership and governance, administration and funding, capacity building, infrastructure and technology, team work, and evidence-based practice. Indigenous approaches included the vision for holistic health, culturally appropriate services, community engagement, shared responsibility, and cultural safety. The program outcomes were identified for biological, mental, and emotional dimensions of oral health; however, measurement of the spiritual dimension was missing. CONCLUSION: Our results suggest that a multiple integrated primary oral health care approach with a particular focus on Indigenous culture seems to be efficient and relevant in improving Indigenous oral health.

Relational continuity of oral health care in Indigenous communities: a qualitative study.

BACKGROUND: The relational continuity of care is an essential function of primary health care. This study reports on the perspectives of Cree communities and their primary health care providers regarding the barriers and enablers of relational continuity of oral health care integrated at a primary health care organization. METHODS: A multiple case study design within a qualitative approach and developmental evaluation methodology were used to conduct this research study in Cree communities of Northern Québec. Maximum variation sampling and snowball techniques were used to recruit the participants. Data collection consisted of individual interviews and focus group discussions. Thematic analysis was conducted which included transcription, debriefing, codification, data display, and interpretation. The consolidated criteria for reporting qualitative studies (COREQ) were used to guide the reporting of study findings. RESULTS: A total of six focus group discussions and 36 individual interviews were conducted. Five major themes emerged from the thematic analyses for barriers (two) and enablers (three). Themes for barriers included impermanence and lack of effective communication, whereas themes for enablers included culturally competent professionals, working across professional boundaries, and proactive organizational engagement. CONCLUSIONS: Based on these findings, relational continuity can be empowered by effective strategies for overcoming barriers and encouraging enablers, such as recruitment of permanent professionals, organizing cultural competency training, development of a Cree language dental glossary, encouraging inter-professional collaboration, and promoting the organization's efforts.

Facilitators and Barriers to Traditional Food Consumption in the Cree Community of Mistissini, Northern Quebec.

To identify barriers to traditional food consumption and factors that facilitate it among the Cree community of Mistissini, a series of four focus groups was conducted with a total of twenty-three people. Two ecological models were created, one for facilitating factors and a second for obstacles, illustrating the role of numerous interconnected influences of traditional food consumption. Environmental impact project, laws and regulation, local businesses, traditional knowledge, youth influence, employment status, and nonconvenience of traditional food were named among numerous factors influencing traditional food consumption. The findings of this study can be used by political and public health organizations to promote traditional food where more emphasis should be invested in community and environmental strategies.

Anthropological perspectives on Miyupimaatisiiun and the integration of oral health in primary care in the Cree communities of Northern Quebec.

The integration of primary oral health care has a pivotal role in improving oral health outcomes and providing accessible and affordable health care. This article contributes to the deep understanding of the cultural aspects of the integration of oral health into primary health care at an Indigenous health organization. Proceeding from a collaborative and interdisciplinary research project evaluating the integration of oral health care within primary care in Eeyou Istchee, this research is based on group discussions (6) and individual interviews (36) with 74 participants (care providers, administrators, and patients) held in four Eastern James Bay Cree communities. This study anthropologically explored participants' perceptions about primary health care conceptualizations, culturally based approaches, and experiences of oral care services at this organization using a "two-eyed seeing" Indigenous framework. The study identified three key factors related to the integration of primary oral health care: Cree perception of primary health and oral health care, cultural safety, and health provider-patient communication and the role of silence. Study findings reflected a dichotomy of perception of primary health care and the relevant units of care between the Cree structural and cultural perspective and the non-Cree professional perspective. The Cree people perceived "household" as a unit of care in comparison to non-Cree who viewed "health care services" as units of care. Our results also underline the role of cultural safety agents to address the needs for cultural competence and the role of silence as implicit cultural protocol. Our anthropological analysis illustrates the potential for increasing the level of appreciation for both users and workers in oral care in the future by ameliorating communication skills and intercultural knowledge.

Appreciative inquiry in evaluating integrated primary oral health services in Quebec Cree communities: a qualitative multiple case study.

OBJECTIVE: The Strategic Regional Plan of the Cree Board of Health and Social Services of James Bay (CBHSSJB), serving the Quebec Cree communities, mandates the objective of integrating oral health within primary healthcare. Emerging evidence suggests that the integration of oral health into primary healthcare can decrease oral health disparities. This research study aimed to answer the following research question: how and to what extent does the integration of oral health into primary healthcare address the oral health needs of the Cree communities? DESIGN: We used a multiple-case study design within a qualitative approach and developmental evaluation methodology. The Discovery, Dream, Design and Destiny model of appreciative inquiry was selected as a study framework among existing frameworks of the developmental evaluation. SETTING: Four purposefully selected Cree communities. PARTICIPANTS: Healthcare providers, administrators and patients at the community wellness centres and hospital. OUTCOME MEASURES: Integration of oral health into primary healthcare. RESULTS: A total of 36 interviews and 6 focus group discussions were conducted. We identified ten themes in discovery and dream phases. The Discovery phase identified the strengths of the organisation in facilitating enablers of integration including strategic planning, organisational structure, cultural integration, coordinated networks and colocation. In the Dream phase, participants' oral healthcare stories expressed various dimensions of integration and their wish for strengthening integration via extending public oral healthcare programmes, increasing resources and improving organisational management. In the Design phase, recommendations were formulated for a future action plan within the CBHSSJB. CONCLUSION: This study results suggested that the CBHSSJB has been successful in implementing oral health integration into primary care following its strategic planning. At present, the organisation could extend the level of integration into full integration by following study recommendations derived from the perspective of local stakeholders.

The Canadian Core Cariology Curriculum: Outcomes of a national symposium.

Despite the efforts that have been made in dental education and clinical practice to adopt the evidence-informed, risk-based, nonsurgical caries management approach, the surgical treatment approach continues to prevail. There is an urgent need to understand resistance to such a paradigm shift and establish a coordinated evidence-based Cariology teaching approach in Canadian dental schools so trainees are equipped to implement caries management in their practice. To work towards this goal, a two-day interinstitutional symposium was organized in Montreal, QC, bringing together clinical and research experts in cariology and dental education from all 10 Canadian dental schools to develop a consensus on an evidence-informed Core Cariology Curriculum, and strategies for its implementation. Through consensus, participants produced the Core Cariology Curriculum for Canadian dental schools and articulated the challenges and solutions for its implementation. Future work will include working collaboratively on the curriculum integration and evaluation.

Patients' perspectives on integrated oral healthcare in a northern Quebec Indigenous primary health care organisation: a qualitative study.

OBJECTIVE: Patient-centred care is considered to be an important element in the evaluation of integrated healthcare and has been effective in addressing oral health disparities. This study explored the patients' perspectives of patient-centred integrated care in oral health services integrated into a primary healthcare organisation serving a northern Quebec Cree population. DESIGN: This study used a multiple case study design within a qualitative approach and developmental evaluation methodology. Two theoretical models, Picker's Principles of Patient-Centred Care and Valentijn's Rainbow Model of Integrated Care, guided data collection and data analysis. The thematic analysis included transcription, debriefing, codification, data display and interpretation. SETTING: This study was conducted in purposefully selected four Cree communities of Northern Quebec. PARTICIPANTS: Adult patients in need of oral healthcare and who attended the local dental clinic were identified and recruited by maximum variation sampling and snowball techniques. OUTCOME MEASURES: Patients' perspectives of patient-centred integrated oral healthcare. RESULTS: Data analysis generated six major themes: enhanced accessibility, creating supportive environment, building trust through shared decision making, appreciation of public health programmes, raising oral health awareness and growing cultural humility among healthcare providers. Patients identified the integration of dental care into primary healthcare with respect to co-location, provision of free oral healthcare services, care coordination and continuity of care, referral services, developing supportive environment, shared decision making, oral health promotion and culturally competent care. CONCLUSION: These results confirmed that patient-centred care is an important element of integrated care. Patients valued the use of this concept in all domains and levels of integration. They recommended to further strengthen the clinical integration by involving parents in oral health promotion as well as optimising care coordination and empowering a supportive environment in organisational integration.

Cariology Education in Canadian Dental Schools: Where Are We? Where Do We Need to Go?

The aim of this study was to document cariology education across Canadian dental schools. Ten faculty members who supervise cariology education at each of the ten Canadian dental schools were invited to participate in the study in 2016. An adapted version of the European Organization for Caries Research-Association for Dental Education in Europe cariology curriculum group questionnaire was used. Representatives of all ten dental schools completed the questionnaire, for a 100% response rate. In four schools, cariology and restorative dentistry were taught by the same department. Five schools had didactic/laboratory courses focusing primarily on cariology as well as a specific written curriculum. Six schools provided cariology-related hands-on workshops/laboratories before students started working with patients. In teaching cariology, seven institutions included dental hard tissues defects. The following caries detection methods were addressed didactically in cariology education: visual (10/10 total schools), tactile (9/10), International Caries Detection and Assessment System criteria (6/10), caries activity assessment (9/10), radiographic (10/10), and other detection tools (8/10). Seven schools charted activity of carious lesions in clinic. Only one school used the concept of caries risk assessment regularly in clinic. Clinical cariology teaching was carried out mostly by private dentists hired as clinical instructors (7/10) and faculty members involved in didactic cariology education (9/10). Calibration of faculty members for caries detection criteria was reported by only one school. The main concern reported by all institutions was the difficulty of implementing didactic instruction on cariology into clinical training. This study found that contemporary cariology concepts are in the process of being implemented in didactic education across Canadian dental schools, but all schools lacked appropriate integration of cariology education into clinical training. These findings suggest a need for harmonization of evidence-based cariology education in Canada.

Barriers and facilitators in the integration of oral health into primary care: a scoping review.

OBJECTIVE: This scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care. METHODS: Grounded in the Rainbow conceptual model and using the Levac et al six-stage framework, we performed a systematic search of electronic databases, organisational websites and grey literature from 1978 to April 2016. All publications with a focus on the integration of oral health into primary care were included except commentaries and editorials. Thematic analyses were performed to synthesise the results. RESULTS: From a total of 1619 citations, 58 publications were included in the review. Barrier-related themes included: lack of political leadership and healthcare policies; implementation challenges; discipline-oriented education; lack of continuity of care and services and patients' oral healthcare needs. The facilitators of integration were supportive policies and resources allocation, interdisciplinary education, collaborative practices between dental and other healthcare professionals, presence of local strategic leaders and geographical proximity. DISCUSSION AND PUBLIC HEALTH IMPLICATIONS: This work has advanced the knowledge on the barriers and facilitators at each integration domain and level, which may be helpful if the healthcare organisations decide to integrate oral health and dental services into primary care. The scoping review findings could be useful for both dental and medical workforce and allied primary healthcare providers. They could also guide the development of healthcare policies that support collaborative practices and patient-centred care in the field of primary care.

Integration of oral health into primary care: a scoping review protocol.

INTRODUCTION: Integrated care has been introduced as a means of improving health outcomes and access to care, and reducing the cost of healthcare. Despite its importance, the integration of oral health into primary care is still an emerging healthcare pathway. This scoping review protocol has been developed and funded by the Canadian Institutes of Health Research to provide an evidence-based synthesis on a primary oral healthcare approach and its effectiveness in improving oral health outcomes. METHODS AND ANALYSIS: The 6-stage framework developed by Levac et al underpins this scoping review. We will identify relevant existing theories, programmes and original research through a comprehensive and systematic search of electronic databases such as OVID (MEDLINE, EMBASE, Cochrane databases), NCBI (PubMed), EBSCOhost (CINAHL), ProQuest, Databases in Public Health, Databases of the National Institutes of Health (health management and health technology) and relevant organisational websites and other sources of grey literature. All types of studies from 1978 to May 2016 in the French and English languages will be included. Using the Rainbow conceptual model of integrative primary care, a qualitative descriptive approach and thematic analysis will be used to synthesise the literature. Implementing novel healthcare models necessitates identifying barriers, sharing knowledge and delivering information. The integration of oral healthcare into primary care is an approach that promotes breaking the boundaries separating oral healthcare professionals and primary care. It creates opportunities for the dental workforce to become more involved in community-based practice and to assume shared responsibility with healthcare professionals to address the unmet oral health needs of those experiencing vulnerability and marginalisation. ETHICS AND DISSEMINATION: The scoping study has received approval from the Université de Montréal's Institutional Review Board (#14-097-CERES-D). The findings will be disseminated through publications and presentations in provincial, national and international research symposiums and professional meetings.

A mixed methods inquiry into the determinants of traditional food consumption among three Cree communities of Eeyou Istchee from an ecological perspective.

BACKGROUND: The Aboriginal nations of Canada have higher incidences of chronic diseases, coinciding with profound changes in their environment, lifestyle and diet. Traditional foods can protect against the risks of chronic disease. However, their consumption is in decline, and little is known about the complex mechanisms underlying this trend. OBJECTIVE: To identify the factors involved in traditional food consumption by Cree Aboriginal people living in 3 communities in northern Quebec, Canada. Design. A mixed methods explanatory design, including focus group interviews to interpret the results of logistic regression. METHODS: This study includes a secondary data analysis of a cross-sectional survey of 3 Cree communities (n=374) and 4 focus group interviews (n=23). In the first, quantitative phase of the study, data were collected using a food-frequency questionnaire along with a structured questionnaire. Subsequently, the focus group interviews helped explain and build on the results of logistic regressions. RESULTS: People who consume traditional food 3 days or more weekly were more likely to be 40 years old and over, to walk 30 minutes or more per day, not to have completed their schooling, to live in Mistissini and to be a hunter (p<0.05 for all comparisons). The focus group participants provided explanations for the quantitative analysis results or completed them. For example, although no statistical association was found, focus group participants believed that employment acts as both a facilitator and a barrier to traditional food consumption, rendering the effect undetectable. In addition, focus group participants suggested that traditional food consumption is the result of multiple interconnected influences, including individual, family, community and environmental influences, rather than a single factor. CONCLUSION: This study sheds light on a number of factors that are unique to traditional foods, factors that have been understudied to date. Efforts to promote and maintain traditional food consumption could improve the overall health and wellbeing of Cree communities.