Pandemic preparedness in dental education: A US-based national survey.

OBJECTIVES: The Coronavirus Disease-19 (COVID-19) pandemic highlighted the need for pandemic preparedness (PP) in health professions training. We aimed to (1) establish a current profile on curricular content of PP in US dental schools and (2) examine how schools were adapting their curricula in response to COVID-19. METHODS: An online survey was developed and sent to senior leadership to all 66 Commission on Dental Accreditation (CODA)-accredited US dental schools including Deans of Academic or Clinical Affairs from November 2020-February 2021. Questions addressed PP curricular content, teaching methods, and evaluation. Participants were asked about the barriers and facilitators for the inclusion of this content. The survey also included questions on redeployment of the clinical workforce in response to the pandemic. RESULTS: The response rate was 31.8% (n = 21) with representation from every US Census Bureau-designated division. While all responding dental schools agreed that dental professionals can play an important role during pandemics, 38.1% reported including content on PP into their pre- or postdoctoral curriculum. In response to the COVID-19 pandemic, approximately 47.6% indicated redeployment of their clinical workforce to participate in disaster life support, assisting physicians in COVID-19 cases, and assisting hospitals with personal protective equipment (PPE). CONCLUSION: There was general agreement that dental professionals can play an important role during pandemics. The participating US dental schools responded to the COVID-19 pandemic by integrating novel clinical activities. More efforts are required to include PP in dental education.

Interprofessional value-based health care: Nurse practitioner-dentist model.

OBJECTIVES: The United States health system is challenged to improve patient and population health, enhance patients' experience of care, and reduce health care costs. Value-based health care (VBHC) models are proposed to address these issues. Medical health systems are making strides toward VBHC, whereas dental care systems lag behind. The aims of this paper are to a) present study findings of an interprofessional practice model integrating oral health and primary care in a dental practice setting, and b) discuss practice and research implications for advancing VBHC approaches in oral health. METHODS: A nonexperimental research method was employed to evaluate the Nurse Practitioner-Dentist Model for Primary Care (NPD Model) at the Harvard Dental Center. Pretest/post-test design was used to assess clinical patient outcomes for a convenience cohort of Medicare beneficiaries (n = 31) with a reported diagnosis of hypertension and/or type 2 diabetes. Clinical outcome measures included: blood pressure, weight, body mass index (BMI), and Hemoglobin A1c. RESULTS: Positive and significant improvements in biometrics (blood pressure, body weight, BMI, HbA1c) were found. CONCLUSIONS: The NPD Model is an early prototype for interprofessional VBHC in oral health and holds promise for improving patient and population health outcomes. Integration of interprofessional VBHC in oral health is an imperative for achieving the Triple Aim to improve the overall health of our nation.

Primary Care and Oral Health Integration: Comparing Training Across Disciplines.

BACKGROUND: Primary care (PC) training programs must incorporate oral health (OH) into their curricula to reduce health disparities. The purpose of this study was to evaluate and compare OH education integration across multiple PC disciplines. METHODS: In 2017, the authors surveyed deans and program directors (PDs) across 13 disciplines (2,245 PC programs) and used the Input Process Output framework to evaluate training factors across these disciplines. RESULTS: Nine disciplines represented by 767 respondents were chosen for analysis (disciplines with ³40% response rate were included). Most of the physician assistant (PA) and pediatric nurse practitioner (PNP) programs reported departmental support for OH and covered curriculum content topics on oral health risk assessment and evaluation. Similarly, over-half (>60%) PA and PNP PDs agreed that learners could answer OH-related questions on their board exams. CONCLUSION: Best practices learned from PNP and PA programs can be shared across disciplines to help bolster OH integration.

Older Adult Patients' Experience of Care in a Dental School Clinic.

The aim of this study was to assess older adults' experience of care in an academic dental practice to identify opportunities to improve the patient experience for older adults. A cross-sectional descriptive survey design with a sample of adults aged 65 and older was conducted using the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) 12-month survey 2.0, with supplemental survey item sets addressing cultural competence and health literacy. A total of 850 older adults were invited to participate in the survey in fall 2016, and a 43% response rate was achieved. Overall, participants reported a positive experience of care and high ratings for their dental providers. Significant differences were found based on age, education level, race, and health status. A significantly more favorable experience of care was reported by patients aged 75 and older, as well as adults without any college education. Non-white patients were less likely to highly rate their dental providers and gave lower ratings for experiencing trust with their dental providers than white patients. Patients reporting good/fair/poor health were also less likely than those reporting very good/excellent health to highly rate their dental providers, and they gave lower ratings for patient-provider communication. This study demonstrated the feasibility of using the CG-CAHPS survey to assess the patient experience for older adults in an academic dental practice. Results identified opportunities for improving the dental practice and underscored the importance of enhancing dental curricula in areas of cultural competence, health literacy, and diversity.

Integrating Oral Health Curricula into Midwifery Graduate Programs: Results of a US Survey.

INTRODUCTION: Midwives are a significant segment of the US maternal and primary health care workforce and play a pivotal role in addressing women's oral health care needs during pregnancy and throughout their life span. The purpose of this research was to assess oral health curricular integration in midwifery programs and examine factors that influence integration and satisfaction with graduates' level of oral health competence. METHODS: A cross-sectional, national survey of midwifery programs was conducted using an electronically distributed 19-item, self-administered questionnaire completed by the Directors of Midwifery Education. Data analysis included univariate and bivariate statistics. RESULTS: All of the responding midwifery programs (N = 33) were educating their graduates about oral health; however, less than a quarter (22.6%) of program directors were satisfied with their graduates' competency. Significant factors promoting integration were routine teaching by a dental professional and a formal relationship with a dental school, dental residency, or dental hygiene program. Programs with 4 or more hours of oral health curriculum were more likely to have a faculty oral health champion, use simulation in evaluation of their learners, and include interprofessional oral health education. DISCUSSION: With adequate oral health education, midwives are ideally positioned to integrate oral health in pregnancy care as well as well woman care throughout the life span, thereby expanding access to oral health care.

Integrating oral health curricula into nurse practitioner graduate programs: Results of a US survey.

BACKGROUND AND PURPOSE: Nurse practitioners (NPs) are a significant segment of the US primary care workforce and have a pivotal role in improving access to oral health (OH) care. The purpose of this research was to assess OH curricular integration in primary care NP programs and to examine factors that influence integration and satisfaction with graduates' level of OH competence. METHODS: A cross-sectional, national survey of NP programs (N = 466) was conducted using an electronically distributed 19-item, self-administered questionnaire. Data analysis included univariate, bivariate, multivariate statistics, and logistic regression modeling. CONCLUSIONS: The large majority of pediatric, family, and adult-gerontology primary care programs are educating NP graduates about OH. Significant factors promoting integration and satisfaction with graduates' level of competence included the presence of a faculty champion and routine teaching by a dental professional or nondental OH expert. IMPLICATIONS FOR PRACTICE: With adequate OH education, NPs are ideally positioned to integrate OH and primary care services in practice, thereby, improving access to OH care.

A Cooperative Education Model for Promoting Oral Health and Primary Care Integration within a Health Care for the Homeless Program.

This report describes an innovative cooperative education model for promoting the integration of oral health and primary care in a safety-net setting for homeless populations. The model situates health sciences students as change agents within the health care team to facilitate interprofessional collaboration and medical-dental integration.

A Novel Interprofessional Faculty Approach for Integrating Oral Health Promotion Competencies into a Physical Therapist Curriculum.

AIMS: Oral health is integral to overall health and wellness. All healthcare providers can contribute to improving health by including an oral health screening (OHS) in the physical examination. The aims of this study were to 1) develop and test a novel oral health curriculum and 2) compare the effectiveness of two distinct methods of instruction, a) simulation with physical therapists (PT) and dental professional co-debriefing and b) video observation with PT faculty- only instruction. METHODS: PT students (n=202) completed one of two educational experiences to learn how to perform an OHS, evaluate oral health findings, provide oral health education, and make an appropriate dental referral. Four distinct patient-specific cases were tested. RESULTS: Results indicated multiple teaching strategies, including a simulation with co-debriefing, improved PT student performance in OHS. Between-case analysis indicated that students performed better in making appropriate referrals for pathology-based cases than preventative care-based cases. Conversely students' patient education was better for preventative cases than pathology-based cases. Curricular revisions improved student performance in providing relevant patient education. A comparison of student performance using simulation with co-debriefing vs video observation with PT faculty-only instruction found no statistically significant difference. CONCLUSIONS: This novel oral health curriculum is a useful approach for teaching PT and other health professions students how to execute an OHS.

Integration of systematic clinical interprofessional training in a student-faculty collaborative primary care practice.

The changing healthcare environment and movement toward team-based care are contemporary challenges confronting health professional education. The primary care workforce must be prepared with recent national interprofessional competencies to practice and lead in this changing environment. From 2012 to 2014, the weekly Beth Israel Deaconess Crimson Care Collaborative Student-Faculty Practice collaborated with Northeastern University to develop, implement and evaluate an innovative model that incorporated interprofessional education into primary care practice with the goal of improving student understanding of, and ability to deliver quality, team-based care. In the monthly interprofessional clinic, an educational curriculum empowered students with evidence-based, team-based care principles. Integration of nursing, pharmacy, medicine, and masters of public health students and faculty into direct patient care, provided the opportunity to practice skills. The TeamSTEPPS® Teamwork Attitudes Questionnaire was administered pre- and post-intervention to assess its perceived impact. Seventeen students completed the post-intervention survey. Survey data indicated very positive attitudes towards team-based care at baseline. Significant improvements were reported in attitudes towards situation monitoring, limiting personal conflict, administration support and communication. However, small, but statistically significant declines were seen on one team structure and two communication items. Our program provides further evidence for the use of interprofessional training in primary care.

Physician Assistant Student Perceptions of an Interprofessional, Peer-to-Peer Oral Health Curriculum Led by Dental Students.

PURPOSE: Physician assistants (PA) are health care team members who often work in primary care. Providing oral health education to PAs during training could improve oral health for vulnerable patients who seek treatment in the primary care setting and who are less able to access dental care. The purpose of this study was to assess the effectiveness of a peer-to-peer oral health curriculum taught by dental students to their PA student colleagues. METHODS: Dental students presented an interactive, case-based curriculum, followed by a hands-on oral examination training session. PA student feedback was obtained, and results were analyzed. RESULTS: Students found the content to be highly relevant and well presented. Conveying oral health competencies to future primary care providers may reduce oral health disparities. CONCLUSIONS: PA students reported improved understanding of oral health and indicated they would incorporate what they had learned into their future clinical practice.

Expanding collaborative boundaries in nursing education and practice: The nurse practitioner-dentist model for primary care.

The purpose of this paper is to describe the design and implementation of a novel interprofessional collaborative practice education program for nurse practitioner and dental students, the Nurse Practitioner-Dentist Model for Primary Care (NPD Program). The NPD Program expands collaborative boundaries in advanced practice nursing by integrating primary care within an academic dental practice. The dental practice is located in a large, urban city in the Northeast United States and provides comprehensive dental services to vulnerable and underserved patients across the age spectrum. The NPD Program is a hybrid curriculum comprised of online learning, interprofessional collaborative practice-based leadership and teamwork training, and clinical rotations focused on the oral-systemic health connection. Practice-based learning promotes the development of leadership and team-based competencies. Nurse practitioners emerge with the requisite interprofessional collaborative practice competencies to improve oral and systemic health outcomes.

Innovations in oral health: A toolkit for interprofessional education.

The integration of oral health competencies into non-dental health professions curricula can serve as an effective driver for interprofessional education (IPE). The purpose of this report is to describe a replicable oral-health-driven IPE model and corresponding online toolkit, both of which were developed as part of the Innovations in Oral Health (IOH): Technology, Instruction, Practice, and Service programme at Bouvé College of Health Sciences, Northeastern University, USA. Tooth decay is a largely preventable disease that is connected to overall health and wellness, and it affects the majority of adults and a fifth of children in the United States. To prepare all health professionals to address this problem, the IOH model couples programming from the online resource Smiles for Life: A National Oral Health Curriculum with experiential learning opportunities designed for undergraduate and graduate students that include simulation-learning (technology), hands-on workshops and didactic sessions (instruction), and opportunities for both cooperative education (practice) and community-based learning (service). The IOH Toolkit provides the means for others to replicate portions of the IOH model or to establish a large-scale IPE initiative that will support the creation of an interprofessional workforce-one equipped with oral health competencies and ready for collaborative practice.

Faculty Readiness for Oral Health Integration into Health Care Professional Education: A Pilot Study.

PURPOSE: Despite mounting evidence of the oral-systemic link, oral health is often treated as a separate entity in health care professional education and training. Faculty attitudes and levels of knowledge and skills related to oral health have been cited as barriers to integration, though no research has reported health care faculty's oral health knowledge and skills or attitudes towards oral health curricular integration. The aim of this study was to assess the oral health knowledge, skills, and attitudes of interdisciplinary health care faculty at a large, metropolitan university. METHODS: A 25-item, web-based survey was distributed to 350 faculty members across nine academic health care programs during the 2013-2014 academic year. RESULTS: A response rate of 13% (n=45) was achieved. Findings indicated overall positive faculty attitudes towards oral health integration, but significant gaps in faculty oral health knowledge and oral health clinical skills. A one-way ANOVA analysis revealed statistically significant differences in oral health clinical skills between faculty of different disciplines. CONCLUSION: This study is the first to assess health care faculty's oral health knowledge and skills and their attitudes towards oral health curricular integration. Findings highlight potential areas for faculty development, education, and training in oral health.

Integrating oral health into the interdisciplinary health sciences curriculum.

Oral health inequities for older adults warrant new models of interprofessional education and collaborative practice. The Innovations in Interprofessional Oral Health: Technology, Instruction, Practice and Service curricular model at Bouvé College of Health Sciences aims to transform health professions education and primary care practice to meet global and local oral health challenges. Innovations in simulation and experiential learning help to advance interprofessional education and integrate oral health care as an essential component of comprehensive primary health care. The Program of All-Inclusive Care for the Elderly clinic is an exemplary model of patient-centeredness and interprofessional collaborative practice for addressing unmet oral health needs of its patient population.

Integrating oral health into professional nursing practice: an interprofessional faculty tool kit.

Millions of children and adults in the United States have unmet oral health care needs, and professional nurses can play a central role in reducing oral health disparities and expanding access to care. Interprofessional education is requisite to improving oral health care outcomes. Baccalaureate nursing programs need to prepare collaborative practice-ready professional nurses to improve oral health care especially for vulnerable and underserved individuals, communities, and populations. This article presents an interprofessional faculty tool kit that builds upon The Essentials of Baccalaureate Education for Professional Nursing Practice as a framework for preparing professional nurses with basic knowledge, skills, and attitudes in oral health promotion and disease and injury prevention across the life cycle. Expectations for professional nursing practice are described within the context of The Essentials and contemporary oral health care issues. Exemplars of interprofessional teaching-learning strategies are provided to assist nurse faculty with integrating oral health into baccalaureate nursing curriculum. Nurse educators are called to prioritize oral health as an essential component of overall health and well-being, increase the visibility of evidence-based oral health promotion and disease and injury prevention in baccalaureate nursing curricula, and support interprofessional oral health education and collaborative care.

Oral health nursing education and practice program.

Millions of Americans have unmet oral healthcare needs and profound oral health disparities persist in vulnerable and underserved populations, especially poor children, older adults, and racial and ethnic minorities. Nurses can play a significant role in improving the quality of oral health including access to care with appropriate education and training. The purpose of this paper is to describe New York University College of Nursing's response to this challenge. The Oral Health Nursing Education and Practice (OHNEP) program is a national initiative aimed at preparing a nursing workforce with the competencies to prioritize oral disease prevention and health promotion, provide evidence-based oral healthcare in a variety of practice settings, and collaborate in interprofessional teams across the healthcare system. The overarching goal of this national initiative is to create an educational infrastructure for the nursing profession that advances nursing's contribution to reducing oral health disparities across the lifespan.

Nurse faculty enrichment and competency development in oral-systemic health.

Nurses are positioned to play a significant role in oral health promotion and disease prevention across the life cycle. Oral health has not been a high priority in nursing practice, and educating nurses about oral health has been inadequate particularly regarding the interrelationship between oral health and overall health. The first step for developing a nursing workforce with core competencies in oral health promotion and disease prevention is to prepare nurse faculty with the requisite knowledge, skills, attitudes, and best practices in oral-systemic health. The purpose of this paper is to present Smiles for Life: A National Oral Health Curriculum as a knowledge framework that nurse faculty can use for faculty enrichment and competency development in oral health across the life cycle. A variety of teaching-learning strategies and resources are provided to assist nurse faculty with integrating oral-systemic health into existing nursing curricula.