How do we teach simulation-based dental education? Time for an evidence-based, best-practice framework.

Historically, simulation-based dental education was taught using practical skills and the action of doing. An increased awareness of the importance of patient safety in healthcare education and delivery has seen considerable advances in the application of simulation-based education across several healthcare disciplines including medicine, nursing and anaesthetics. Dental simulation-based education requires improved standards of best-practice, and evidence-based, curriculum design that is based on theoretical frameworks, conceptual frameworks and educational theories. In this commentary, we explore the educational theory and the development of healthcare simulation, including internationally recognised standards of best practice and the simulation-based activity cycle. Given simulation-based education should be fit-for purpose, the components of these standards are examined within the specific context of dental education. We propose an evidence-based, best-practice framework that can be applied in the design and delivery of contemporary simulation-based dental curriculum.

"Even if you think you can trust them, don't trust them": An exploratory analysis of the lived experiences of sexual health among sexual minority girls in foster care.

Girls in foster care are at heightened risk for poor sexual health outcomes compared to their general population counterparts. Sexual minority girls are also at greater risk for poor sexual health compared to their heterosexual counterparts. Yet, little is known about the sexual health of sexual minority girls in foster care. This study aims to provide a preliminary understanding of how sexual minority girls in foster care experience the phenomenon of sexual health. Using a single-case interpretative phenomenological analysis (IPA) design, we interviewed five sexual minority girls in foster care using a single in-depth focus group discussion and analyzed the data using a series of IPA steps. Analysis revealed three major themes about the lived experiences of sexual health among sexual minority girls in foster care: fear of being victimized and distrust within sexual relationships, self-protection from sexual relationship harm, and sexual health communication. Further research is warranted to investigate the sexual health experiences and needs of sexual minority girls in foster care, with particular sensitivity to the potential impact of past sexual victimization and abuse on their sexual health and wellbeing.

Leadership and career development curriculum in Australian dental and oral health programmes.

INTRODUCTION: There is very little evidence of dental schools offering leadership or career development training for students. Given that tertiary students come from diverse backgrounds with differing experiences, it is important that all students learn skills that improve their employability by preparing them for a range of career paths and equipping them with the confidence to lead their profession into the future. This study mapped current leadership and career development training in dental education programmes throughout Australia, focusing on the capacity, barriers and enablers. METHODS: In 2018, an electronic survey was sent to the Program Convenors of all nineteen dental programmes in Australia. Survey questions were sourced from existing literature and the current regulatory competencies. RESULTS: Whilst the majority of respondents (n = 17, 89% response rate) indicated that their programmes included both leadership training (72%) and career development activities (88%), it is clear that the content focus, hours allocated and assessment items vary widely across the country. Further, curriculum appeared to focus almost exclusively on clinical work, which does not provide an avenue for students to explore alternative, non-clinical career options or pathways or develop their skills beyond treating individual patients. Time constraints and ideological differences were reported as the biggest barriers to implementing leadership and career development curricula. CONCLUSION: Despite an inconsistent approach nationally, it appears there is an opportunity for faculty across institutions to collaborate, potentially to develop a set of leadership and career development competencies and best practice teaching and learning activities.

Ergonomic interventions for preventing musculoskeletal disorders in dental care practitioners.

BACKGROUND: Dentistry is a profession with a high prevalence of work-related musculoskeletal disorders (WMSD) among practitioners, with symptoms often starting as early in the career as the student phase. Ergonomic interventions in physical, cognitive, and organisational domains have been suggested to prevent their occurrence, but evidence of their effects remains unclear. OBJECTIVES: To assess the effect of ergonomic interventions for the prevention of work-related musculoskeletal disorders among dental care practitioners. SEARCH METHODS: We searched CENTRAL, MEDLINE PubMed, Embase, PsycINFO ProQuest, NIOSHTIC, NIOSHTIC-2, HSELINE, CISDOC (OSH-UPDATE), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP) Search Portal to August 2018, without language or date restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs, and cluster RCTs, in which participants were adults, aged 18 and older, who were engaged in the practice of dentistry. At least 75% of them had to be free from musculoskeletal pain at baseline. We only included studies that measured at least one of our primary outcomes; i.e. physician diagnosed WMSD, self-reported pain, or work functioning. DATA COLLECTION AND ANALYSIS: Three authors independently screened and selected 20 potentially eligible references from 946 relevant references identified from the search results. Based on the full-text screening, we included two studies, excluded 16 studies, and two are awaiting classification. Four review authors independently extracted data, and two authors assessed the risk of bias. We calculated the mean difference (MD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% confidence intervals for dichotomous outcomes. We assessed the quality of the evidence for each outcome using the GRADE approach. MAIN RESULTS: We included two RCTs (212 participants), one of which was a cluster-randomised trial. Adjusting for the design effect from clustering, reduced the total sample size to 210. Both studies were carried out in dental clinics and assessed ergonomic interventions in the physical domain, one by evaluating a multi-faceted ergonomic intervention, which consisted of imparting knowledge and training about ergonomics, work station modification, training and surveying ergonomics at the work station, and a regular exercise program; the other by studying the effectiveness of two different types of instrument used for scaling in preventing WMSDs. We were unable to combine the results from the two studies because of the diversity of interventions and outcomes.Physical ergonomic interventions. Based on one study, there is very low-quality evidence that a multi-faceted intervention has no clear effect on dentists' risk of WMSD in the thighs (RR 0.57, 95% CI 0.23 to 1.42; 102 participants), or feet (RR 0.64, 95% CI 0.29 to 1.41; 102 participants) when compared to no intervention over a six-month period. Based on one study, there is low-quality evidence of no clear difference in elbow pain (MD -0.14, 95% CI -0.39 to 0.11; 110 participants), or shoulder pain (MD -0.32, 95% CI -0.75 to 0.11; 110 participants) in participants who used light weight curettes with wider handles or heavier curettes with narrow handles for scaling over a 16-week period.Cognitive ergonomic interventions. We found no studies evaluating the effectiveness of cognitive ergonomic interventions.Organisational ergonomic interventions. We found no studies evaluating the effectiveness of organisational ergonomic interventions. AUTHORS' CONCLUSIONS: There is very low-quality evidence from one study showing that a multi-faceted intervention has no clear effect on dentists' risk of WMSD in the thighs or feet when compared to no intervention over a six-month period. This was a poorly conducted study with several shortcomings and errors in statistical analysis of data. There is low-quality evidence from one study showing no clear difference in elbow pain or shoulder pain in participants using light weight, wider handled curettes or heavier and narrow handled curettes for scaling over a 16-week period.We did not find any studies evaluating the effectiveness of cognitive ergonomic interventions or organisational ergonomic interventions.Our ability to draw definitive conclusions is restricted by the paucity of suitable studies available to us, and the high risk of bias of the studies that are available. This review highlights the need for well-designed, conducted, and reported RCTs, with long-term follow-up that assess prevention strategies for WMSDs among dental care practitioners.

CYP1B1 copy number variation is not a major contributor to primary congenital glaucoma.

PURPOSE: To evaluate the prevalence and the diagnostic utility of testing for CYP1B1 copy number variation (CNV) in primary congenital glaucoma (PCG) cases unexplained by CYP1B1 point mutations in The Australian and New Zealand Registry of Advanced Glaucoma. METHODS: In total, 50 PCG cases either heterozygous for disease-causing variants or with no CYP1B1 sequence variants were included in the study. CYP1B1 CNV was analyzed by Multiplex Ligation-dependent Probe Amplification (MLPA). RESULTS: No deletions or duplications were found in any of the cases. CONCLUSION: This is the first study to report on CYP1B1 CNV in PCG cases. Our findings show that this mechanism is not a major contributor to the phenotype and is of limited diagnostic utility.

GSDMB/ORMDL3 Rare/Common Variants Are Associated with Inhaled Corticosteroid Response among Children with Asthma.

Inhaled corticosteroids (ICS) are efficacious in the treatment of asthma, which affects more than 300 million people in the world. While genome-wide association studies have identified genes involved in differential treatment responses to ICS in asthma, few studies have evaluated the effects of combined rare and common variants on ICS response among children with asthma. Among children with asthma treated with ICS with whole exome sequencing (WES) data in the PrecisionLink Biobank (91 White and 20 Black children), we examined the effect and contribution of rare and common variants with hospitalizations or emergency department visits. For 12 regions previously associated with asthma and ICS response (DPP10, FBXL7, NDFIP1, TBXT, GLCCI1, HDAC9, TBXAS1, STAT6, GSDMB/ORMDL3, CRHR1, GNGT2, FCER2), we used the combined sum test for the sequence kernel association test (SKAT) adjusting for age, sex, and BMI and stratified by race. Validation was conducted in the Biorepository and Integrative Genomics (BIG) Initiative (83 White and 134 Black children). Using a Bonferroni threshold for the 12 regions tested (i.e., 0.05/12 = 0.004), GSDMB/ORMDL3 was significantly associated with ICS response for the combined effect of rare and common variants (p-value = 0.003) among White children in the PrecisionLink Biobank and replicated in the BIG Initiative (p-value = 0.02). Using WES data, the combined effect of rare and common variants for GSDMB/ORMDL3 was associated with ICS response among asthmatic children in the PrecisionLink Biobank and replicated in the BIG Initiative. This proof-of-concept study demonstrates the power of biobanks of pediatric real-life populations in asthma genomic investigations.

Investigation into the enablers and barriers of career satisfaction among Australian oral health therapists.

OBJECTIVES: This qualitative study explored the enablers and barriers of career satisfaction among Australian oral health therapists (OHTs) and the reasons behind career changes. METHODS: Participants were recruited in 2 ways: 1) recruitment posts were made on the Facebook pages of two professional groups; and 2) an email was sent to the Doctor of Dental Medicine students of the University of Sydney School of Dentistry, inviting those with OHT qualifications to participate. Each participant completed a semi-structured interview which was guided by open-ended questions. The average interview length was 45 min. All interviews were recorded, transcribed verbatim and manually coded. Thematic analysis of the qualitative data was completed using an inductive approach. RESULTS: Twenty-one OHTs participated in this study. The enablers of OHT career satisfaction include clinical practice, job variety, career flexibility, being in a supportive team environment and the opportunity for constant learning and growth. The barriers to career satisfaction include musculoskeletal problems, restrictions on the scope of practice use, psychological stress and lack of recognition from others. OHTs remain in the profession due to stable income and employment opportunities. The main reasons for retirement were burnout and pursuing dentistry. OHTs pursue dentistry to expand their scope of practice. CONCLUSION: This study revealed the enablers and barriers of OHT career satisfaction in an Australian context. OHTs are an important component of modern dental workforces, and reasons for attrition within the workforce are essential for maintaining responsiveness to community oral health needs.

Factors affecting chiropractor requests for full-length spinal radiography: A scoping review.

Chiropractors often refer their patients for full-length (three- to four-region) radiographs of the spine as part of their clinical assessment, which are frequently completed by radiographers in medical imaging practices. Overuse of spinal radiography by chiropractors has previously been reported and remains a contentious issue. The purpose of this scoping review was to explore the issues surrounding the utilisation of full-length spinal radiography by chiropractors and examine the alignment of this practice with current evidence. A search of four databases (AMED, EMBASE, MedLine and Scopus) and a hand search of Google was conducted using keywords. Articles were screened against an inclusion/exclusion criterion for relevance. Themes and findings were extracted from eligible articles, and evidence was synthesised using a narrative approach. In total, 25 articles were identified, five major themes were extracted, and subsequent conclusions drawn by authors were charted to identify confluent findings. This review identified a paucity of literature addressing this issue and an underrepresentation of relevant perspectives from radiographers. Several issues surrounding the use of full-length spinal radiography by chiropractors were identified and examined, including barriers to the adherence of published guidelines for spinal imaging, an absence of a reporting mechanism for the utilisation of spinal radiography in chiropractic and the existence of a spectrum of beliefs amongst chiropractors about the clinical utility and limitations of full-length spinal radiography. Further investigation is required to further understand the scope of this issue and its impacts for radiation protection and patient safety.

Improving Hearing Protection Device Noise Attenuation Through Fit-Testing in an Occupational Health Clinic.

BACKGROUND: Occupational noise-induced hearing loss (NIHL) is the second most common medical disability for military veterans and accounts for 24% of all hearing loss in the United States. Hearing loss negatively affects health and billions of dollars are spent annually for direct and indirect medical costs and lost work productivity. Proper hearing protection device (HPD) fit can prevent NIHL. Quantitative fit-testing systems to determine personal attenuation rates (PARs) are available, but not widely utilized. Without quantitative testing, validating appropriate fit and attenuation to a permissible exposure level to prevent NIHL is difficult. METHODS: A quality improvement project measured 100 employees enrolled in a hearing conservation program (HCP) to determine if they obtained a target PAR after inserting the HPDs in their "usual" fashion. Those who did not obtain target PAR (n = 27) received an evidence-based intervention that demonstrated proper HPD fit by a skilled trainer followed by a repeat attempt by the participant to replicate the feel of the demonstrated HPD placement. PAR was subsequently measured to assess for appropriate noise attenuation. FINDINGS: Seventy-one percent achieved target PAR (≥ 20 decibels) at baseline testing. After the intervention, 91 of 100 participants had achieved target PAR, a 20% improvement. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Findings suggest this evidence-based intervention was an effective strategy for improving HPD fit for employees enrolled in HCPs. This intervention may prevent occupational hearing loss and decrease the health and socioeconomic impacts of NIHL.

Australian dental practitioner perspectives on academic careers.

OBJECTIVES: Due to forecasted faculty shortages and increasing student enrollments in dental education, there is a need to attract talented clinicians into academia. To address this growing concern, we need to explore dental practitioners' perspectives on the academic career pathway, including enablers and barriers to entering the academic workforce. METHODS: A mixed-methods electronic survey was disseminated through professional associations and dental groups on social media in 2018. Qualitative responses were examined using an inductive thematic analysis. RESULTS: Participants (n = 85) considered an academic career highly regarded (80%) but indicated there was not a clear pathway (79%) and could not recall it being discussed during their dental studies (85%). It was perceived that experience, further study, and networks all played a significant role in forging an academic career. Perceived benefits to an academic career included professional development opportunities, good employment conditions, and making a meaningful contribution. Barriers included the geographical location of universities, losing clinical skills and the lack of a clear career pathway. CONCLUSION: Despite being a highly regarded career, clinicians admit the career pathway to academia is not clear. Improving awareness of academic career paths might be achieved by educating dental students and providing accessible resources to the wider profession.

A global review of the education and career pathways of dental therapists, dental hygienists and oral health therapists.

Introduction With ongoing needs in oral healthcare being unmet, dental therapists, dental hygienists and oral health therapists have the potential to assume greater roles and responsibilities in the provision of care. This review provides a global overview of the education and career opportunities of these professions, contributing to the discussion on the future trajectories of all three professions.Methods A scoping review was conducted to collate and summarise the current available evidence from peer-reviewed journal articles, published reports and books, and websites of professional associations and government agencies.Results Of the 145 sources identified and reviewed, 53 were included in the qualitative synthesis. The themes were categorised into domains: 1) dental therapy; 2) dental hygiene; and 3) oral health therapy.Conclusion The results of this review indicated that, although there has been continuous advocacy for dental therapists, dental hygienists and oral health therapists to assume roles beyond the traditional clinical practice, the majority of the professionals still mainly practise as clinicians. Many dental therapists, dental hygienists and oral health therapists felt limited by their scope of practice and were dissatisfied with the lack of career pathways. Additional research is needed to examine the influences behind career development for all three professions.

What informs oral health and chronic disease policy development in Australia: a citation analysis.

Improvement of health services and patient outcomes depends on the translation of health research into health policy. Oral health research can inform policies to manage chronic diseases and improve quality of life of affected individuals. To determine if translation of this research into policy is occurring, we identify where policymakers obtain evidence to inform the development of Australian health policy. We conducted a citation analysis of oral health, cardiovascular disease, diabetes and cognitive impairment National policies to determine if current oral health research has informed oral health and chronic disease policy. We analysed five National policies with 268 individual references to policy or organizational documents (n = 179), peer-reviewed research (n = 74), grey literature (n = 12), or unidentifiable (n = 3). Although we found oral health references listed in the National policies (92), we did not find this information to have been translated into the oral health and chronic disease policies we analysed.

Dental and oral health students' perceptions of loupes.

Objectives. The dental industry has embraced the usage of loupes, with recent literature identifying numerous clinical and ergonomic benefits. Despite the growing usage of loupes among Australian dental professionals and dental students, few data regarding the perceived benefits and limitations of their use in clinical practice are available. The aim of this study was to examine the experiences and opinions of loupe usage among Australian dental and oral health students. Methods. A self-reporting questionnaire was distributed to all dental and oral health students across Australia during 2016. Results. A total of 223 students responded to the questionnaire. Of these responses, 45.7% reported they wear loupes during their clinical training, with the majority (32%) purchasing them due to recommendation by a demonstrator. Primary benefits reported included ergonomics/posture (89%), restoration evaluation/detection (72%) and quality of care/improved patient care (63%). Primary limitations reported included infection control (53%), decreased awareness of patients' non-verbal communications (44%) and vision dependency (30%). Conclusions. Overall, the students in this study identified both benefits and limitations to wearing loupes in clinical practice. Despite this, an overwhelming majority (96%) of those who used loupes would recommend them to other dental and/or oral health students.

An international review of musculoskeletal disorders in the dental hygiene profession.

This review of the current literature is aimed at examining musculoskeletal disorders in dental hygienists, and investigates the complex nature of this significant occupational health issue. Musculoskeletal disorders (MSD) have been identified as a significant issue for the profession of dental hygiene. The purpose of this review is to examine and assemble the best evidence on the epidemiology, diagnosis, treatment, interventions, prevention, impact and consequences of MSD among the dental hygiene profession. The prevalence of MSD is alarming, with up to 96% reporting pain, and a number of occupational risk factors have been identified by the literature. Studies investigating interventions are generally limited in their study design, which is concerning given the huge impact MSD can have on the practising dental hygienist. Overall, it is evident from the literature that MSD is a complex and multifactorial problem. However, a complete understanding of the progression of musculoskeletal disorders is still far from being realised, due to the lack of longitudinal studies and standardised research techniques. Future research should implement triangulation methods in longitudinal studies, a strategy which will go a long way in the understanding of this complex occupational health issue.

A scoping review of simulation-based dental education.

This article was migrated. The article was marked as recommended. In order to meet the needs of student learning within a competency-based pedagogy, it is necessary to understand the current philosophies and modalities being used in dental and oral health simulation-based education. The aim of this literature review is to identify the existing research relating to the educational structure of dental and oral health simulation activities. The review is presented as a scoping review, formulated and conducted using a modified five stage methodological framework. Despite evidence showing that the healthcare simulation model is ideal for learning and assessments of non-clinical and clinical tasks such as psychomotor skills, there is a paucity of published literature relating to simulation in dental and oral health education. Out of 72 initial articles only six papers related to dental preclinical psychomotor skills in an educational setting, none of which were deemed high-quality. Deficiencies in these papers included no statements defining underpinning educational theory, limited acknowledgement of evidence-based simulation activities including preparation, briefing, simulation, feedback, debriefing, reflection and evaluation. Given the widespread use of simulation in dentistry, academics should be encouraged to publish their scholarly activities in simulation-based dental education in order so that all dental faculties can work towards developing contemporary simulation curriculum to provide optimum teaching and learning opportunities for students.

How does the 'care of the self' impact on fitness to practice in dental education?

This article was migrated. The article was marked as recommended. Foucault defines care of the self as activities which "permit individuals to effect by their own means or with the help of others a certain number of operations on their own bodies and souls, thoughts, conduct, and way of being, so as to transform themselves in order to attain a certain state of happiness, purity, wisdom perfection, or immortality" ( Foucault, 1988). This paper will explore how the care of the self impacts on fitness to practice in dental education. Fitness to practice refers to a student's competence, including clinical skills and professionalism as well as the ability to reflect on their own health and capabilities. This paper will examine how the dominant discourse of reflective practice influences a student's care of the self using techniques of writing and verbalisation, and how the development of competent graduates is tied to Foucault's work on disciplinary power, panopticism and governmentality. The role of pastoral power and confession, and the relationship of educators and students will also be explored.

The Effect of Stainless Steel and Silicone Instruments on Hand Comfort and Strength: A pilot study.

Purpose: Many dental hygienists experience musculoskeletal pain during the course of their careers, often as a result of the sustained grips on instruments and repetitive movements employed during clinical practice. Current research suggests that lighter instruments with a larger diameter reduce force and load on the hand during scaling procedures; therefore, the texture and weight of silicone handles is designed to decrease the strain placed on the hand and fingers. The purpose of this research is to investigate and compare the effect of silicone instrument handles and traditional stainless steel instrument handles on hand comfort and strength.Methods: This pilot study used a comparative cross-sectional study design. A convenience sample of dental hygiene students (n= 23) participated in two simulated scaling sessions for 30 minutes, one week apart. During the first session, students were required to use traditional stainless steel instruments (10mm diameter and 21-26g weight), while during the second session students used instruments with silicone handles. Students were required to complete a Hand Health Profile and perform hand strength tests following each session. Paired t-tests were used to determine significant differences between the grip strength, pinch strength and hand health profiles scores after using stainless steel and silicone instrument handles.Results: The data analyses revealed a statistically significant improvement in grip strength (p<0.02), key pinch strength (p<0.05) and overall hand comfort (p<0.001).Conclusions: This study suggests that the use of silicone instrument handles may improve hand comfort and reduce hand fatigue. These findings should prompt further investigation on ergonomic instrument design.

Developing Professionalism in Dentistry: A Systematic Review.

This article was migrated. The article was marked as recommended. Background: Professionalism is a core competency and concern in all health professional education. Evidence from nursing and medicine suggests the evidence base for approaches to developing and assessing professionalism at undergraduate level is weak. In 2015, notifications, imposed sanctions, and in some cases de-registration against dental practitioners for reported incidences of breaches in infection control in New South Wales, Australia, have refreshed the essential need for dental practitioners to promote public safety and protection. Aim: To investigate the evidence for clinical education practice approaches to develop professionalism in dentistry. Methods: Relevant electronic databases were searched for full-text peer reviewed papers relating to dental practitioners published between 2000 and June 2016 in English. All research designs were included. Following initial and detailed screening, included papers were independently quality appraised and strength of evidence graded by two independent reviewers. Results: Removal of duplicates resulted in 195 unique papers; following screening 34 full text articles were assessed for eligibility resulting in 15 papers evaluated in this review. Eight different clinical education approaches were identified. Most studies were of low quality and reported low levels of educational outcomes based on Kirkpatrick's Hierarchy. There is a lack of good quality evidence to support any one approach to develop professionalism in dentistry. What evidence there is focuses on low level educational outcomes such as learners experience. Conclusions: Low level outcomes is common in educational research and therefore unsurprising. More disappointing was failure to adequately justify the methodology and the absence on the definition of dental professionalism. The research findings is consistent with the evidence across other health professions internationally. There is scope for an inter-professional approach to tackle the challenge developing and subsequently assessing professionalism.

Cultural Competency Education in Academic Dental Institutions in Australia and New Zealand: A Survey Study.

The aim of this study was to assess the status of cultural competency education in Australian and New Zealand dental, dental hygiene, and oral health therapy programs. The study sought to explore the extent to which cultural competence is included in these programs' curricula, building on similar studies conducted in the United States and thus contributing to the international body of knowledge on this topic. A 12-item instrument was designed with questions in four areas (demographics, content of cultural competency education, organization of overall program curriculum, and educational methods used to teach cultural competence) and was sent to all Australian and New Zealand dental, dental hygiene, and oral health therapy educational programs. Of the total 24 programs, 15 responded for a response rate of 62.5%. The results showed that lectures were the most frequent teaching method used in cultural competency education; however, the variation in responses indicated inconsistencies across study participants, as discussions and self-directed learning also featured prominently in the responses. The majority of respondents reported that cultural competence was not taught as a specific course but rather integrated into their programs' existing curricula. The variations in methods may indicate the need for a standardized framework for cultural competency education in these countries. In addition, the notion of cultural competency education in academic dental institutions demands additional evaluation, and further research is required to develop a solid evidence base on which to develop cultural competency education, specifically regarding content, most effective pedagogies, and assessment of student preparedness.