Problems and Solutions for Interprofessional Education in North American Dental Schools

Interprofessional education (IPE) is a relatively new part of dental education. Its implementation is mandated by accreditation standards, but it is also essential to good patient care. Diverse dental schools from various regions of North America outline problems they have faced in IPE and the solutions that they have found to surmount these problems. Commonalities and unique features of these problems and solutions are discussed.

Key points

  • Interprofessional education (IPE) must be clinically relevant to our students. Therefore, IPE cases must promote teamwork, be applicable to dental care, and be authentic.

  • Relevance and learning are enhanced by moving from the classroom to clinical care and by the use of actual or simulated cases.

  • There is no need to reinvent the wheel, but assessments should be calibrated and evidence based. Learning objectives and assessments can be adapted from high-quality preexisting resources.

  • Learning in a community setting promotes recognition of discipline-specific biases and can help to create sustainable interprofessional resources.

  • Sustainability is enhanced by an effort to overcome institutional barriers and by embedding IPE/interprofessional collaborative practice in the fabric of the institution.

Introduction

Interprofessional education (IPE) and interprofessional collaborative practice (ICP) are relatively new to most health professional schools in North America. Dental accreditation authorities in Canada and the United States recognize their importance to good patient care and in 2013 adopted new accreditation standards, which mandate that IPE be part of dental education. Standard 2-19 of the 2016 Predoctoral Accreditation Standards of the USA Commission on Dental Accreditation states, “Graduates must be competent in communicating and collaborating with other members of the health care team to facilitate the provision of health care.” Dental schools face some unique problems because unlike MDs or nurses, most dentists do not participate in hospital-based practice, and many IPE activities simulate hospital scenarios. Furthermore, in North America, oral health care often follows a different track from general health care, including practice locations, practitioner attitudes, and billing practices, reinforcing the false impression that the mouth is not part of the body. Oral health can be fully integrated into ICP only if all providers fully understand its importance to our patients’ overall health.

Just as graduate dentists concentrating on treatment of dental disease may need to be reminded about basic medical science, general physicians and other health care professionals need to be reminded about the oral cavity’s place in the body and to think of the teeth as well as the toes when they consider patient health. All health care workers, not just dentists, need to change the conversation from oral health is connected to systemic health toward oral health is integral to overall health because characterizing it as a connection rather than a synthesis is an understatement.

We also need to change the culture of dentistry from only addressing the what (the procedure to be done) at the exclusion of the why (the diagnosis and reason for treatment). It could be argued that attempts to simply integrate oral health into primary care via nurse practitioners (NPs) and physician assistants (applying fluoride varnish, learning to do oral examinations, and so forth) is detrimental to ICP because it does little to alter the reciprocal education needed to truly understand and respect each other’s roles. The dental team needs education, collaboration, and practice with other health care professionals; other health care professionals need education, collaboration, and practice with us.

Palatta and colleagues say “IPE and collaborative practice have surfaced as among the most significant changes to health care education and delivery in the 21st century.” Nonetheless, its implementation in dental schools faces numerous hurdles. Palatta and colleagues surveyed dental schools and found the most important perceived barriers to IPE implementation include funding limitations, lack of curricular time, and assessment of student learning. Rafter and colleagues found similar results when they interviewed leaders at 7 key academic health centers who stated that the major hurdles include lack of curricular time, funding limitations, lack of scientific evidence for effectiveness of IPE, and lack of support by faculty and administration, including poor communication between health profession schools and the perception that IPE is a fad. Dental hygiene schools seem to face similar barriers. Furgeson and colleagues surveyed US dental hygiene schools and identified that the most important anticipated future barriers are scheduling and logistics, lack of programs with which to collaborate, and lack of administrative support.

This article attempts to turn the conversation toward solutions. Diverse Canadian and US dental schools report the range of problems that they have faced during their introduction of IPE and discuss the solutions that they have found in a brief format. These contributions are shown next.

Introduction

Interprofessional education (IPE) and interprofessional collaborative practice (ICP) are relatively new to most health professional schools in North America. Dental accreditation authorities in Canada and the United States recognize their importance to good patient care and in 2013 adopted new accreditation standards, which mandate that IPE be part of dental education. Standard 2-19 of the 2016 Predoctoral Accreditation Standards of the USA Commission on Dental Accreditation states, “Graduates must be competent in communicating and collaborating with other members of the health care team to facilitate the provision of health care.” Dental schools face some unique problems because unlike MDs or nurses, most dentists do not participate in hospital-based practice, and many IPE activities simulate hospital scenarios. Furthermore, in North America, oral health care often follows a different track from general health care, including practice locations, practitioner attitudes, and billing practices, reinforcing the false impression that the mouth is not part of the body. Oral health can be fully integrated into ICP only if all providers fully understand its importance to our patients’ overall health.

Just as graduate dentists concentrating on treatment of dental disease may need to be reminded about basic medical science, general physicians and other health care professionals need to be reminded about the oral cavity’s place in the body and to think of the teeth as well as the toes when they consider patient health. All health care workers, not just dentists, need to change the conversation from oral health is connected to systemic health toward oral health is integral to overall health because characterizing it as a connection rather than a synthesis is an understatement.

We also need to change the culture of dentistry from only addressing the what (the procedure to be done) at the exclusion of the why (the diagnosis and reason for treatment). It could be argued that attempts to simply integrate oral health into primary care via nurse practitioners (NPs) and physician assistants (applying fluoride varnish, learning to do oral examinations, and so forth) is detrimental to ICP because it does little to alter the reciprocal education needed to truly understand and respect each other’s roles. The dental team needs education, collaboration, and practice with other health care professionals; other health care professionals need education, collaboration, and practice with us.

Palatta and colleagues say “IPE and collaborative practice have surfaced as among the most significant changes to health care education and delivery in the 21st century.” Nonetheless, its implementation in dental schools faces numerous hurdles. Palatta and colleagues surveyed dental schools and found the most important perceived barriers to IPE implementation include funding limitations, lack of curricular time, and assessment of student learning. Rafter and colleagues found similar results when they interviewed leaders at 7 key academic health centers who stated that the major hurdles include lack of curricular time, funding limitations, lack of scientific evidence for effectiveness of IPE, and lack of support by faculty and administration, including poor communication between health profession schools and the perception that IPE is a fad. Dental hygiene schools seem to face similar barriers. Furgeson and colleagues surveyed US dental hygiene schools and identified that the most important anticipated future barriers are scheduling and logistics, lack of programs with which to collaborate, and lack of administrative support.

This article attempts to turn the conversation toward solutions. Diverse Canadian and US dental schools report the range of problems that they have faced during their introduction of IPE and discuss the solutions that they have found in a brief format. These contributions are shown next.

Problem 1: how do we make interprofessional education clinical requirements more relevant and flexible?

Karen Burgess DDS, MSc, FRCD (Canada) and Sylvia Langlois MSc, OT Reg (Ontario), University of Toronto

The University of Toronto (UT) IPE curriculum for 11 health profession programs requires students to interact with each other’s professions. The IPE component in clinical placements typically occurs in hospital inpatient units, where many of the university health programs work side by side. Because clinical experiences for dentistry students are completed within the faculty patient clinics, dental students do not have a hospital placement where they interact with students from the other health professions. Dental students also report that some IPE activities do not apply to them and they cannot participate fully in the discussions, particularly when activities relate to inpatients and topics like discharge planning.

Solutions

UT faculty from dentistry and the Center for IPE jointly designed community IPE activities that were more relevant and flexible for dental students. The resulting Flexible Model enables dental students to complete core requirements, yet permits enough flexibility to ensure that learning opportunities meet student learning needs and faculty requirements. Dental students participate in each of the 3 learning activities in the Flexible Model. Each activity involves at least one other profession and is structured to include a briefing, an experience, a formalized debriefing, and a reflective writing assignment. Learning experiences for students in each of these activities are as follows:

  • Participation in interprofessional team education: When a medical emergency occurs at the dentist’s office, the team must call 911. This time is one of the most stressful times in practice. Dental students and paramedics work together to find the best ways to manage medical emergencies in practice and learn about 911 calls at the Toronto 911 Call Center. Dental students learn how to deal with 911 calls effectively and efficiently and to develop an appreciation of patients’ needs. This experience promotes an understanding of how dentists should communicate and collaborate with paramedical staff to ensure efficient and effective responses.

  • Interviewing/shadowing a team member: Dental students shadow dental laboratory technologists at a community dental laboratory. They develop an appreciation of the laboratory technologists’ roles and responsibilities and what is required to interact as team members. Together, they find ways to enhance communication to benefit patients.

  • Participation in team meetings: Dental students participate with other students in team meetings with registered nurses, patients, and families to plan and then provide care.

Discussion

Dental students want experiences that expand on existing dental training but will also help them in their professional life after graduation. These learning activities are highly valued by dental students who need to be engaged in some learning activities with professions that will be their partners in future practice. As future practitioners in a community office, students need to consider unique competencies required to address patient concerns in a comprehensive and collaborative manner. Interactions with paramedics and dental laboratory technologists promote an appreciation of scope of practice, roles and responsibilities of these community-based professions, and how to communicate and collaborate to enhance best practices in patient care. Dental students also are exposed to a traditional team meeting with involvement of both patients and family members. Flexibility in the original design of the mandatory structured IPE clinical experience enables full participation of dental students so they can develop needed collaborative competencies.

Problem 2: how do we move beyond the classroom to the clinical environment?

Kenneth Allen DDS, MBA and Judith Haber PhD, APRN, BC, FAAN, New York University

Identifying effective strategies for teaching health professions students how to collaborate as effective team members is a challenge. The transformation of health care delivery will occur in clinical settings at the point of care. Providers across disciplines will be expected to transcend traditional professional silos, partnering to achieve the outcomes for which they are accountable.

Solutions

New York University (NYU) has developed a large interprofessional clinical simulation and case study experience, embedding the Interprofessional Education Collaborative (IPEC) competencies and creating a relevant clinical focus for 3 different health professions. Oral-systemic health is the perfect clinical exemplar to bring together 168 medical (Doctor of Medicine [MD]), 84 dental (Doctor of Dental Surgery [DDS]), and 100 NP students. The New York Simulation Center for the Health Sciences has 14 glass-enclosed, fully-equipped examination rooms with video recording capabilities and conference rooms for case study sessions. Faculty members trained in IPE facilitate collaboration using a brief-and-debrief approach to begin and close each session. Using standardized patients, students collaborate to teach each other to complete oral, cardiac, and respiratory assessments. Teach back demonstrations provide evidence of clinical competence. The interprofessional case study experience, focused on a patient with symptoms of diabetes and periodontal disease, requires NP, DDS, and MD students to integrate the IPEC competencies and clinical assessment, diagnosis, and management competencies to develop a management plan.

Discussion

Transcending schedules of 330 students in 3 different schools, each with a different course and credit configuration, required weeks of advanced planning and flexibility. Developing a faculty leadership team committed to transcending professional silos was an evolutionary process. Now in its third year, the Teaching Oral-Systemic Health experience has become a standardized component of the curriculum in all 3 professional schools. Faculty development continues to be an essential ingredient for success. More than 90% of faculty members evaluate the experience very positively as a valuable interprofessional experience for faculty and students. Using the Interprofessional Collaborative Competency Attainment Survey, a 20-item valid and reliable tool that aligns with the IPEC competencies, students complete pre-event and post-event surveys that assess the degree to which they change their attitudes and perceptions of the importance of interprofessional experiences. Evaluation data reveal a statistically significant change from before to after the test ( P <.001) across the dental, medical, and nursing professions.

It is essential to have support from leaders of the academic units; it is they who commit to allocating the resources integral with successful interprofessional initiatives. Engaging faculty champions is important; whether faculty are formal or informal leaders, their buy-in will be important in growing a critical mass of early adopters. Exposing students to interprofessional clinical experiences provides an opportunity for future health professionals to learn from and about each other’s roles and responsibilities as well as how to communicate and collaborate. The aim is that positive student interprofessional clinical experiences will prepare graduates to join clinical teams as effective collaborators. The success of this program has provided a catalyst for developing interprofessional live clinical experiences involving smaller groups of NP, DDS, and MD students. The authors’ goal is to acquire more curricular resources to expand the program so that it includes every student and, ideally, does this more than once per year.

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Oct 25, 2016 | Posted by in General Dentistry | Comments Off on Problems and Solutions for Interprofessional Education in North American Dental Schools
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