Presence of management, entrepreneurship, leadership and marketing topics in the dental school curriculum in Brazil.

INTRODUCTION: To analyse the presence and characteristics of curricular components related to management, entrepreneurship, leadership and marketing as part of the structure and teaching methods of undergraduate courses in dentistry in Brazil. MATERIALS AND METHODS: This is an observational study that used the Ministry of Education's Undergraduate Course Accreditation Platform, which included 424 undergraduate courses in Dentistry on the last date of collection (August 31 2019). The following items were analysed as follows: the existence of curricular components in relation to the proposed themes, the most recurring denominations of curricular components, minimum and maximum workload, mandatory/optional classification, theoretical/practical teaching condition and in which year the curricular components were inserted. RESULTS: 367/424 (86.6%) of dentistry courses in Brazil included at least one of the topics: management, entrepreneurship, leadership and marketing curricular components in their curriculum, whilst 57/424 (13.4%) did not have these curricular components in their curricular structure. The most frequent names were "Management" 99 (45.21%) and "Entrepreneurship" 80 (36.5%). There was a predominance of the "theoretical method" and the number of hours varied considerably, with the most common course hours between 40 and 60 h. The majority of curricular components were inserted in the third to fifth year and offered on a compulsory basis. CONCLUSION: Most curricular matrices of dentistry courses in Brazil had components related to the topics studied. However, due to the variety of curricular components' names, hours, periods of courses and different teaching methodologies, there is a need to redesign the teaching and learning process, defining educational and evaluation models with common curricular components.

How school life with international students develops the intercultural competence of domestic dental students.

INTRODUCTION: Reflecting multicultural society, the diversity of the healthcare professional students' ethnicities and cultures is promoted around the world. However, most of the healthcare professional education in Japan had been targeted mainly at students who follow the Japanese language and culture. The aim of this study is to clarify what Japanese dental students have culturally experienced and how they developed intercultural competence during their school life with international dental students in Japan. MATERIALS AND METHODS: We conducted semi-structured interviews with 18 of the sixth-grade students in standard Japanese undergraduate dental programmes who shared required classes in Japan with non-Japanese-speaking international dental students in preclinical programmes. Based on the qualitative analysis of the interviews, we administered a questionnaire survey to 82 dental trainees (the seventh grade) in clinical training programmes who just graduated from various Japanese dental schools. Then, the answers of the questionnaire were statically analysed. RESULTS: The interview identified a total of 37 constituent elements regarding "students' attitudes and experiences in school days" and "perceptions and motivations." Analysis of the questionnaire showed that the group experiencing a learning environment with international students had various communication with and respect for their various classmates and had the ambition to develop themselves. Especially, the participants who had international experiences both in and out of classrooms showed more active attitude on intercultural communication. CONCLUSIONS: Overall, for Japanese dental students, daily contact with international students gave direct and indirect cross-cultural experiences and recognitions. In particular, the Japanese students were stimulated active perceptions. The findings of this study can be used for future discussion about the cross-cultural education and collaboration of healthcare professionals not only within Japan but also around the world.

A service-learning framework to address accreditation standards: Self-Assessment, communication skills, health literacy, and cultural competence.

OBJECTIVES: Pre-doctoral dental programs must provide opportunities for students to become proficient in self-assessment, communication skills, health literacy, and cultural competence, essential for independent unsupervised practice. This study aimed to assess how student learning through a classroom education service-learning program addresses the Commission on Dental Accreditation (CODA) standards 2-11 and 2-17; specifically through the examination of self-assessment, communication skills, health literacy, and cultural competence. METHODS: This 2022 retrospective mixed methods cohort study examined unstructured faculty comments on drafted lesson plans and structured evaluations of classroom education service-learning rehearsal sessions. A random sample of faculty comments from three academic years, 2018, 2019, and 2020, were deidentified and analyzed by five researchers for emerging themes using NVivo. Quantitative data from rehearsal presentations were analyzed with descriptive statistics to assess the concordance of self and faculty feedback on specific evaluation criteria. RESULTS: Six major themes from faculty lesson plan feedback emerged: knowledge, professionalism, communication, presentation skills, cultural competence, and program logistics. Concordance between faculty feedback and student self-assessment ranged from 83% to 92.4% across all evaluation criteria over the 3 years: spoke clearly and confidently at the right pace, provided accurate dental terminology and facts, used grade-appropriate language, provided clear instructions to follow, appeared enthusiastic throughout the rehearsal presentation, and designed a well thought out lesson plan that will engage children for the entire presentation. CONCLUSION: Findings support the classroom education service-learning program as a framework to provide opportunities for student self-assessment and feedback on communication skills, health literacy, and cultural competence aligned with CODA standards 2-11 and 2-17.

Evaluation of a student telehealth rotation at the Columbia University College of Dental Medicine.

OBJECTIVES: This study aimed to assess the impact of a telehealth rotation on the perceived benefits and challenges of telehealth use among third-year dental students at the Columbia University College of Dental Medicine (CDM). METHODS: A newly implemented weeklong telehealth rotation at CDM engaged all 95 third-year dental students from the 2022 graduating class through assigned readings and virtual interaction with patients. The telehealth rotation involves virtual visits with patients for screening and triage. An ongoing retrospective assessment of the students' post-rotation evaluation was analyzed qualitatively to identify emerging themes and was coded to describe students' attitudes and beliefs about telehealth. RESULTS: Students reported that the greatest benefit of telehealth is logistical convenience, while the greatest challenge to telehealth is related to the use of technology. After the telehealth rotation, students reported improvement in their clinically relevant skills and knowledge, including patient education, facilitating access to care, and communication skills. CONCLUSIONS: The skills reported by students as the most important learning takeaway from the telehealth rotation are applicable to many aspects of care delivery, beyond the scope of telehealth. The incorporation of telehealth education into dental curricula allows students to improve essential clinically relevant skills and knowledge beyond the procedural skills emphasized during in-person patient appointments.

Evaluation of mindfulness practice in mitigating impostor feelings in dental students.

OBJECTIVES: This study examined (i) the prevalence of impostor feelings in first-year dental students, (ii) student perceptions of a mindfulness practice as a tool to cope with impostor feelings, and (iii) students' ability to identify their level of impostor feelings. METHODS: Two hundred three D1 students at a single institution participated in a mandatory Mind-Body Wellness Course that included the presentation "Understanding Imposter Phenomenon" (lecture #1) and a second presentation "Impostor Phenomenon and Mindfulness: Tools for Success" (lecture #2) 6 months later. Before lecture #2, all students predicted the level to which they suffer from imposter feelings and then took the Clance Impostor Phenomenon Scale (CIPS) to determine the actual level. After lecture #2, 155 of the students completed a survey on whether the mindfulness practices in the lecture impact their perceptions on coping with impostor feelings. RESULTS: Fifty-two percent of students were classified as frequent or intense impostors by the CIPS. Fifty-one percent predicted their CIPS classification correctly; 43% underestimated their impostor classification. After lecture #2, 86% reported feeling confident they could recognize their impostor feelings, and 93% reported feeling more aware of how impostor feelings influence their thoughts, behaviors, and actions. Eighty-six percent reported feeling the mindfulness exercise was a helpful tool to build habits to cope with impostor feelings; 83% reported feeling confident they could utilize mindfulness practices to mitigate these feelings when they arise. CONCLUSIONS: Frequent or intense impostor feelings may be common in first-year dental students. Mindfulness practice has potential to mitigate such impostor feelings.

Opportunities for narrative medicine in dental education and practice, a narrative review.

PURPOSE/OBJECTIVES: Reflection is one of four components of the experiential learning cycle and is often the one overlooked. This practice can be used in graduate-level health care education, such as medicine and dentistry. This metacognitive practice allows students to conceptualize learning in a clinical setting and apply this knowledge to new scenarios. Reflective practice can be taught using different modalities of narrative medicine, and several studies have studied its effectiveness in areas such as professional development, collaboration, communication among others. Most of these studies, however, have been conducted solely in the medical setting, and narrative medicine may have useful application in the practice and teaching of dentistry. METHODS: This literature review examined the outcomes of narrative medicine in medical studies concerning reflection and hypothesized their benefits to dental education. The studies reviewed were chosen by utilizing key term searches of the National Center for Biotechnology Information PubMed library and qualitative factor analysis by study team investigators. Elective-based, prospective enrollment and whole cohort participation programs were analyzed for potential effectiveness in dental education. RESULTS: The most feasible programs for potential integration into dental curricula are elective-based, small-group, graduate-level courses with a level of evaluation such as residency competencies, as demonstrated by Arntfield et al. CONCLUSION(S): These programs should be investigated further to evaluate their potential in improving reflective skills of students, and ultimately in improving their experiential learning experience.

Clinical Excellence in Otolaryngology-Head and Neck Surgery: Examples from the Published Literature.

OBJECTIVE/HYPOTHESIS: To apply the domains of clinical excellence, as published by the Miller-Coulson Academy of Clinical Excellence, to the field of otolaryngology-head and neck surgery (OHNS) as a framework for evaluating and improving clinical excellence. METHODS: A search of PubMed, Scopus, the Cochrane Library, and the National Institute for Health and Care Excellence (NICE) databases was performed and 229 publications were reviewed. RESULTS: Case reports and other articles were selected that exemplify each of the distinct domains of clinical excellence within our specialty. CONCLUSIONS: The Miller-Coulson Academy's domains of clinical excellence are relevant to OHNS and can provide a framework for fostering clinical excellence in otolaryngologists. The many examples of excellent care by otolaryngologists found in the published literature can inspire otolaryngologists to provide outstanding care to all patients consistently and to advance our specialty. LEVEL OF EVIDENCE: N/A Laryngoscope, 131:E2153-E2158, 2021.

Reflective writing in dental education to improve critical thinking and learning: A systematic review.

The Commission on Dental Accreditations states that "graduates must be competent in the use of critical thinking and problem-solving." With this in mind, dental education programs continually strive to enhance and deepen these skills by incorporating effective instructional strategies into the curriculum. To do this, predoctoral dental education has used a variety of techniques including problem-based learning, OSCEs, and standardized patient activities. Another technique, while less popular but potentially more effective if done well, is reflective writing. This study aimed to assess the effect of reflective writing on students' critical thinking skills and learning in dental education programs. Two database searches conducted between 2000 and 2019 resulted in 317 articles after the initial screening. Ultimately, 13 articles met inclusion criteria. The following recurring factors were identified for inclusion in dental education reflective writing initiative: reflective writing interventions, reflective writing instructions, writing prompts, evaluation frameworks, and negative perceptions of reflective writing. In answering the key aim of this review, 12 of the 13 studies determined that reflective writing had a positive impact on students' critical thinking, judgment, and/or learning. Key findings included positive effects on student growth in reflection, learning through reflective writing, reflection skills, self-assessment, critical thinking, clinical reasoning, problem solving, and motivation to change after evaluated experiences. The review indicated that dental education programs, which implemented reflective writing as an assessment tool within the curriculum as a means of developing and deepening critical thinking skills and learning were by and large successful in this effort.

Oral Sex Knowledge and Experience of Transgender Youth: An Opportunity for Dental Education.

Recent evidence suggests that, when compared to their cisgender counterparts, transgender youth exhibit more unsafe sexual behavior that may elevate their risk for sexually transmitted infections. The aim of this study was to better understand what transgender youth know about oral sex, related consequences, and mechanisms of protection and where they obtained this information. The findings can be helpful in preparing oral health providers to play a role in meeting this public health need. The study took place at a U.S. academic pediatric medical center in 2017. Participants were recruited at a Transgender Research Day and during Transgender Clinic sessions. English-speaking transgender adolescents ages 14 to 24 were invited to participate in a previously validated survey about their knowledge and behaviors related to oral sex. Of the 138 transgender youth invited to participate, 57 completed the surveys, for a 41% response rate. Most respondents reported feeling they understood the necessity of protection and consequences of oral sex but did not use protection. Over half of the participants (58%) said they had not had a physician, dentist, or parent speak to them about oral sex. Given the lack of standardized, evidence-based sex education, it is imperative that adolescents, particularly in highly vulnerable populations like transgender youth, receive accurate information about oral sexual contact. Dental schools should prepare future practitioners to address these issues with youth using a culturally competent, evidence-based approach.

Differences in expectations of passing standards in communication skills for pre-clinical and clinical medical students.

OBJECTIVE: Communication and interpersonal skills (CIS) are essential elements of competency-based education. We examined defensible CIS passing levels for medical students completing basic sciences (second-year students) and clinical training (fourth-year students), using five standard setting methods. METHODS: A 14-item CIS scale was used. Data from second-year (n = 190) and fourth-year (n = 170) students were analyzed using descriptive statistics and generalizability studies. Fifteen judges defined borderline CIS performance. Cut scores and fail rates from five standard setting methods (Angoff, Borderline-Group, Borderline-Regression, Contrasting-Groups, and Normative methods) were examined. RESULTS: CIS performance was similar during second-year (Mean = 74%, SD = 6%) and fourth-year (Mean = 72%, SD = 5%) students. Judges using the Angoff method expected greater competence at the fourth-year level, as reflected in the Angoff cut scores (second-year = 53% with 0% fail, fourth-year = 66% with 10% fail). Cut scores from the remaining methods did not differentiate between training levels. We found evidence of case specificity. CONCLUSION: Performance on CIS may be case specific. Passing standards for communication skills may require employing approaches such as the Angoff method that are sensitive to expectations of learner performance for different levels of training, competencies, and milestone levels. PRACTICE IMPLICATIONS: Institutions that want to encourage continued growth in CIS should apply appropriate standard setting methods.

Effectiveness of Motivational Interviewing Training for Primary Care Dentists and Dental Health Technicians: Results from a Community Clinical Trial.

Motivational interviewing (MI) is an approach that uses dialogue about behavioral change to encourage a constructive relationship between professionals and patients. The aim of this study was to evaluate the maintenance of basic MI skills in the daily practice of dentists and oral health technicians (OHTs) after a training course and for two years of follow-up in the context of primary health care (PHC). A randomized community trial, from September 2012 to September 2014, was conducted at the Community Health Service of Conceição Hospital Group in Porto Alegre, RS, Brazil. The experimental group consisted of all 41 dentists and OHTs who received an intensive eight-hour training course in basic MI principles; the control group consisted of 31 dentists and OHTs who did not receive MI training. The follow-up assessments were at one and two years using three instruments validated for MI. In the one- and two-year follow-ups, improvement was maintained in responses with a statistically significant difference for use of open questioning, reflective listening, and total percentage of correct answers (p<0.001), with a large effect size (ES=1.12). On the Helpful Responses Questionnaire, the participants continued using open questioning and reflective listening (p<0.001), maintaining an increase in the percentage of responses compatible with MI (p<0.001). Likewise, the effect size remained large (ES=1.33) over time. These results suggest that the training course with dentists and OHTs of the PHC oral health staff was effective over the two-year follow-up in enabling them to act in the spirit and techniques of MI.

The Use of Social Media by Dental Students for Communication and Learning: Two Viewpoints: Viewpoint 1: Social Media Use Can Benefit Dental Students' Communication and Learning and Viewpoint 2: Potential Problems with Social Media Outweigh Their Benefits for Dental Education.

Social media have become a major part of an interconnected society, impacting personal and professional lives. This Point/Counterpoint presents two opposing viewpoints on the question of whether social media should be used in dental education as a learning and communication tool for dental students. Viewpoint 1 argues that social media benefit student learning and should be used as a tool in dental education. This argument is based on evidence concerning use of social media and improved learning across health professions, improved peer-peer communication in clinical education, improved engagement in interprofessional education (IPE), and provision of a mechanism for safe and improved communication between practitioners and patients, as well as faculty and students. Viewpoint 2 argues that potential problems and risks in using social media outweigh any benefits found in learning and therefore social media should not be used as a tool in dental education. This viewpoint is supported by evidence of negative effects on learning, the establishment of a negative digital footprint in the public's view, risk of privacy violations when using social media, and the new phenomenon of Internet addiction with its negative physiological effects on social media users.

Assessment of Self Perception of Competencies among a Group of Dental interns in Pondicherry, India.

CONTEXT: The general dentist must not only have a broad biomedical and clinical education but also be able to demonstrate professional and ethical behavior as well as effective communication and interpersonal skills. In addition he or she must have the ability to evaluate and utilize emerging technologies, continuing professional development opportunities, and problem-solving and critical thinking skills to effectively address current and future issues in health care. But the extent to which the core competencies are taught and the students' level of proficiency in these competencies in Indian scenario is to be explored at large. AIMS: The present study aims at assessing the self-perceived level of competencies and their importance for future practice and the extent to which the competencies are taught in the curriculum among interns of dental college in Pondicherry, India. SETTINGS AND DESIGN: The cross-sectional observational study was conducted among dental interns of Indira Gandhi Institute of Dental Sciences, Pondicherry. SUBJECTS AND METHODS: A total of 72 interns participated in the study. A short version of the Freiburg Questionnaire to Assess Competencies in Medicine" was used in this study. Questionnaire has three sections with same set of questions, which the student had to rate: (i) To what extent do you have the following competencies at your disposal? (ii) To what extent will your future job require the following competencies? and (iii) To what extent is competencies taught to you? After the results were obtained a focused group discussion with the responders was done. Focused group discussion consisted of open questions to the groups in all the four domains and the responses of the students were scribed. RESULTS: In all four domains, self-perceived level of competency was not satisfactory. However, all students stated that the competencies were highly relevant for their future practice. Despite this, most of the competencies are not taught to necessary extent in the curriculum. The results of the present survey revealed that the participating students perceived deficiencies in all domains of competencies. CONCLUSIONS: These results indicate that the core competencies are still barely integrated into dental curricula and that further research in this field is needed.

Effect of Collaborative Group Testing on Dental Students' Performance and Perceived Learning in an Introductory Comprehensive Care Course.

The use of collaboration while in dental school can help prepare dental students for the team-oriented nature of the workforce. One way to do this is via collaborative group testing (CGT), a method of assessment allowing students to learn from one another. The aim of this study was to examine the CGT method in a predoctoral dental education setting to determine if student examination performance improved with the addition of collaboration and if collaborative testing was beneficial to students' learning process. In 2016, all first-year dental students (n=76) at one U.S. dental school were assessed in an introductory comprehensive care course using a two-stage CGT in which students were assessed individually, prior to taking the same test in collaboration with an assigned partner. Three quizzes and a final examination were given in which student participants served as both control (individual assessments) and treatment (collaborative assessment). At the conclusion of the course, a questionnaire was administered to ascertain student perspectives. All assessments yielded favorable results with an overall score improvement from a mean of 81.1% on individual assessments to 91% on collaborative assessments (p=0.001), indicating that collaboration improved assessment outcomes. Additionally, retention of material was suggested with individual scores on the cumulative final surpassing average individual scores of the preceding quizzes (p<0.001). Students' responses on the questionnaire indicated that they perceived implementation of CGT was beneficial to their learning process. With these results, this testing methodology shows promise to enhance dental student learning, material retention, and teamwork.

Communication Skills Training for Surgical Residents: Learning to Relate to the Needs of Older Adults.

BACKGROUND: It is vital for physicians and surgeons to communicate successfully with older adults, who will constitute one-fifth of the US population by 2030. Older adults often perceive themselves as stigmatized and powerless in healthcare settings. Effective communication leads to better patient compliance and satisfaction, which is now a component of Medicare hospital reimbursement and physician and surgeon compensation from hospitals and networks. OBJECTIVE: To increase orthopaedic surgery resident understanding of the unique needs of older adults in order to maintain effective and sensitive communication with this vulnerable population. DESIGN: A two-part training program (ongoing for 8 years) comprised of: 1) small-group interactive didactic sessions on aging issues; and 2) workshop demonstrations given by the residents to a group of older adults, followed by a Question & Answer session. Residents were assessed using a 22-item pre-post questionnaire covering medical knowledge of aging, attitudes toward older adults, and personal anxiety about aging. Older adult participants were surveyed for perceptions of residents' sensitivity toward them. SETTING: Hospital for Special Surgery in New York City, a specialized urban academic center, with a 5-year Orthopedic Surgery Residency program. PARTICIPANTS: 70 PGY3 residents, for whom the program is a requirement, and 711 older adult participants recruited from a community convenience sample. RESULTS: Older adult participants: Of 711 participants, 672 (95%) responded; 96% strongly agreed/agreed that the residents had demonstrated sensitivity toward them. Residents: Of 70 residents, 35 (50%) were assessed. Mean knowledge scores increased significantly (p ≤ 0.001); five of nine attitude items (p ≤ 0.05) and one of four anxiety items improved significantly (p ≤ 0.001). CONCLUSIONS: Significant change was seen in residents' attitudes and anxiety levels toward older adults, attributes that are usually deep seated and hard to change. Residents moved along the Accreditation Council for Graduate Medical Education Milestones continuum for three core competencies.

Teaching dental students to interact with survivors of traumatic events: development of a two-day module.

Dentists are likely to treat patients who have experienced a wide range of traumatic life events, including child abuse and neglect, domestic violence, sexual assault, elder abuse, and exposure to combat. In order to effectively treat survivors of traumatic events, dentists must understand how these patients may present in oral health settings, the basic mandated reporting requirements related to abuse and neglect, and communication strategies to help engage trauma survivors in dental treatment. A traditional lecture-format educational module on trauma-informed care was developed and implemented for second-year dental students (N=92) at one U.S. dental school, after which a needs assessment was performed (all 92 students participated). This assessment then informed development of an enhanced module for the subsequent group of second-year dental students (N=102) at the same school. The revised (final) module was more interactive in nature, expanded to multiple sessions, and included more discussion of mandated reporting and appropriate dentist-patient communication in relation to traumatic events. All 102 students participated in assessments of the revised module. Comparison of pre and post tests and needs assessments between the initial and final modules indicated that the extended, more interactive final module was more effective in meeting the educational objectives. Results showed that the final module increased the students' knowledge in the health-related manifestations of traumatic events and slightly improved their confidence levels in treating survivors of trauma. Dentists who are prepared to deliver trauma-informed care may help individual patients feel more at ease and increase engagement in regular preventive care. Suggestions for future educational efforts in this area are discussed.

Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors.

BACKGROUND: High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. METHODS: Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties. RESULTS: Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered 'important' or 'extremely important' to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%). DISCUSSION: Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first year of residency training or later. CONCLUSIONS: Gathering data from residency program directors provides support for developing new assessment tools in high-stakes licensing examinations.