Developing the next generation of leaders in oral health.

Given the challenges facing oral health providers as practitioners, community leaders, and educators, expanding dental curricula with an introductory course on leadership is timely and necessary. Such a course will sow the seeds of leadership by defining its importance in the dental profession and creating an understanding that the skills associated with leadership need to be developed over a lifetime. This article reports on a conference session in which a group of faculty members and students discussed the need and value of teaching leadership, compared leadership programs from four U.S. dental schools, and proposed an implementation framework for leadership programs at other dental schools. The moderator led discussion of participants' suggestions for course materials and implementation frameworks in small-group sessions. The participants' responses were captured using standardized worksheets. Time, including faculty members' and students', was considered the biggest barrier to implementing a leadership course. A number of opportunities were identified, including the ability for interprofessional collaboration and the opportunity for students to grow and learn. Creating a core course with optional components was considered the most attractive option. In this experience, the participants gained perspective on the challenges and opportunities for developing a leadership curriculum and were provided with a tangible product for further development.

Dental students' reflections on their experiences with a diverse patient population.

Recent developments, including national reports and new accreditation standards, have emphasized the need for dental students to be prepared to address the needs of a diverse patient population. The purpose of this study was to explore students' descriptions of and reflections on their day-to-day interactions with a diverse patient population in the clinical setting, using a qualitative approach. All dental students (sixty-six) enrolled in the third year of the D.M.D. program at a Midwestern dental school were required to write a paper reflecting on their experiences working with a diverse patient population in the general dental clinic of the school as part of a behavioral sciences course. All third-year dental students were invited to participate in the study. The students' papers were deidentified prior to data analysis. Forty-two students' papers describing a total of 126 patient-student interactions were reviewed. Data analysis resulted in identification of three key themes: 1) development of cultural awareness and recognition of the need to understand each patient as a unique individual, 2) desire to build rapport with all patients, and 3) realization that the development of cultural competence is a lifelong learning process requiring ongoing experiences working with a diverse patient population. Review of student reflection papers is valuable in providing faculty with an understanding of students' degree of development of cultural competence. A greater understanding of students' day-to-day experiences with a diverse patient population can provide insights for dental educators who develop cultural competence curricula.

What is the relationship between emotional intelligence and dental student clinical performance?

Emotional intelligence has emerged as a key factor in differentiating average from outstanding performers in managerial and leadership positions across multiple business settings, but relatively few studies have examined the role of emotional intelligence in the health care professions. The purpose of this study was to examine the relationship between emotional intelligence (EI) and dental student clinical performance. All third- and fourth-year students at a single U.S. dental school were invited to participate. Participation rate was 74 percent (100/136). Dental students' EI was assessed using the Emotional Competence Inventory-University version (ECI-U), a seventy-two-item, 360-degree questionnaire completed by both self and other raters. The ECI-U measured twenty-two EI competencies grouped into four clusters (Self-Awareness, Self-Management, Social Awareness, and Relationship Management). Clinical performance was assessed using the mean grade assigned by clinical preceptors. This grade represents an overall assessment of a student's clinical performance including diagnostic and treatment planning skills, time utilization, preparation and organization, fundamental knowledge, technical skills, self-evaluation, professionalism, and patient management. Additional variables were didactic grade point average (GPA) in Years 1 and 2, preclinical GPA in Years 1 and 2, Dental Admission Test academic average and Perceptual Ability Test scores, year of study, age, and gender. Multiple linear regression analyses were conducted. The Self-Management cluster of competencies (b=0.448, p<0.05) and preclinical GPA (b=0.317, p<0.01) were significantly correlated with mean clinical grade. The Self-Management competencies were emotional self-control, achievement orientation, initiative, trustworthiness, conscientiousness, adaptability, and optimism. In this sample, dental students' EI competencies related to Self-Management were significant predictors of mean clinical grade assigned by preceptors. Emotional intelligence may be an important predictor of clinical performance, which has important implications for students' development during dental school.

Leaders and emotional intelligence: a view from those who follow.

Abstract-Boyatzis and Goleman state that Emotional Intelligence (EI) "is an important predictor of success." In their book Primal Leadership, they refer to "the leadership competencies of emotional intelligence: how leaders handle themselves and their relationships." The leadership exercises reported here examined the practices of effective and ineffective leaders as identified by individuals who have worked under such leaders (ie, followers/subordinates). We sought to ascertain to what extent these practices are related to EI. The 2-year data from these leadership exercises show the strong relationships between perceived leadership effectiveness and emotionally intelligent leadership practices as observed by leaders' followers. For example, whether considering the practices that made effective leaders effective or the practices that ineffective leaders needed to adopt or significantly improve upon (in the eyes of subordinates), these practices were almost exclusively related to EI. These findings are supported in the EI literature, as is the strength of subordinates' assessments in predicting leadership effectiveness.

A multimethod investigation including direct observation of 3751 patient visits to 120 dental offices.

This report defines verbal interactions between practitioners and patients as core activities of dental practice. Trained teams spent four days in 120 Ohio dental practices observing 3751 patient encounters with dentists and hygienists. Direct observation of practice characteristics, procedures performed, and how procedure and nonprocedure time was utilized during patient visits was recorded using a modified Davis Observation Code that classified patient contact time into 24 behavioral categories. Dentist, hygienist, and patient characteristics were gathered by questionnaire. The most common nonprocedure behaviors observed for dentists were chatting, evaluation feedback, history taking, and answering patient questions. Hygienists added preventive counseling. We distinguish between preventive procedures and counseling in actual dental offices that are members of a practice-based research network. Almost a third of the dentist's and half of the hygienist's patient contact time is utilized for nonprocedure behaviors during patient encounters. These interactions may be linked to patient and practitioner satisfaction and effectiveness of self-care instruction.

Virtual reality distraction for pain control during periodontal scaling and root planing procedures.

BACKGROUND: Although pain management during periodontal treatment usually is achieved with anesthesia, alternative methods are available. The authors conducted a study to evaluate the analgesic effect of immersive virtual reality (VR) during periodontal scaling and root planing (SRP) procedures. METHODS: The authors recruited 38 patients. They used a within-patient/split-mouth design. Patients received SRP under three treatment conditions in three quadrants. The three conditions were control, watching a movie and VR. After each SRP procedure, patients responded to questions about their discomfort and/or pain by using a visual analog scale (VAS) (range, 0 to 10 in which lower numbers indicate less pain or discomfort). The authors also recorded patients' blood pressure (BP) and pulse rate (PR). Patients were asked which of the three treatment modalities they preferred. RESULTS: The mean (+/- standard deviation) VAS scores for five questions pertaining to control, movie and VR were 3.95 +/- 2.1, 2.57 +/- 1.8 and 1.76 +/- 1.4, respectively. Paired t tests revealed that VAS scores were significantly lower during VR compared with the movie (P <.001) and control (P <.001) conditions. Similarly, BP and PR were lowest during VR, followed by the movie and control conditions. Patients reported that they preferred the VR condition. CONCLUSION: The results of this study suggest that use of immersive VR distraction may be an effective method of pain control during SRP procedures. CLINICAL IMPLICATIONS: Practitioners can use immersive VR distraction for pain control during SRP procedures.

Tomorrow's leaders, starting today: a pilot leadership development program for dental students.

Effective leadership is vitally important as the dental profession strives to meet current and future challenges. Leadership development programs have been created for mid-career dental professionals, but the relative lack of such programs for dental students may represent a missed opportunity to cultivate the dental leaders of tomorrow. A pilot leadership development program for dental students is described in this article. A voluntary leadership development program for dental students was offered in 2008 at the Case School of Dental Medicine with support from the Ohio Dental Association Foundation. The program aimed to increase students' leadership knowledge, improve their leadership skills, and provide inspiration through exposure to leaders who could serve as role models. At the conclusion of the program, students attended the Ohio Dental Association's Leadership Institute event. Forty-six students attended at least one program session. Thirty students attended all or all but one of the on-site sessions. Thirty-three participants responded to a post-program anonymous online survey. The majority of participants (81 percent) rated the program as very useful or useful and said they would participate in the program again (85 percent). Student attendance at the state dental association's leadership event increased appreciably from previous years. Student participation in the pilot program exceeded expectations. Leadership development programs for dental students are feasible and can benefit students and the dental community.

Concordance of chart and billing data with direct observation in dental practice.

OBJECTIVES: The commonly used methods of chart review, billing data summaries and practitioner self-reporting have not been examined for their ability to validly and reliably represent time use and service delivery in routine dental practice. A more thorough investigation of these data sources would provide insight into the appropriateness of each approach for measuring various clinical behaviors. The aim of this study was to assess the validity of commonly used methods such as dental chart review, billing data, or practitioner self-report compared with a 'gold standard' of information derived from direct observation of routine dental visits. METHODS: A team of trained dental hygienists directly observed 3751 patient visits in 120 dental practices and recorded the behaviors and procedures performed by dentists and hygienists during patient contact time. Following each visit, charts and billing records were reviewed for the performed and billed procedures. Dental providers characterized their frequency of preventive service delivery through self-administered surveys. We standardized the observation and abstraction methods to obtain optimal measures from each of the multiple data sources. Multi-rater kappa coefficients were computed to monitor standardization, while sensitivity, specificity, and kappa coefficients were calculated to compare the various data sources with direct observation. RESULTS: Chart audits were more sensitive than billing data for all observed procedures and demonstrated higher agreement with directly observed data. Chart and billing records were not sensitive for several prevention-related tasks (oral cancer screening and oral hygiene instruction). Provider self-reports of preventive behaviors were always over-estimated compared with direct observation. Inter-method reliability kappa coefficients for 13 procedures ranged from 0.197 to 0.952. CONCLUSIONS: These concordance findings suggest that strengths and weaknesses of data collection sources should be considered when investigating delivery of dental services especially when using practitioner survey data. Future investigations can more fully rely on charted information rather than billing data and provider self-report for most dental procedures, but nonbillable procedures and most counseling interactions will not be captured with routine charting and billing practices.

Leadership development for dental students: what do students think?

Effective leaders are needed to move the dental profession forward, building on past accomplishments, meeting new challenges, and leading innovation and change. There is a lack of research findings regarding students' perceptions of the importance of leadership abilities and/or their interest in developing leadership skills during their dental school experience. The purpose of this study was to explore dental students' perceptions related to leadership development. A forty-seven-question, self-administered, paper and pencil survey was administered to all students enrolled in the D.M.D. program at one Midwestern dental school. The response rate was 83 percent (225/272). The majority of students agreed that it is important for dentists to have leadership skills and that leadership skills can be learned. Most reported that they expect to assume a leadership role in their dental practices (97 percent), to participate in volunteerism in dentistry (85 percent), and to participate in non-dentistry-related leadership roles in the community (72 percent). Over one-third (37 percent) anticipate participating in leadership roles in dental associations, 28 percent in academic dentistry, and 14 percent in military dentistry. Approximately two-thirds of respondents agreed (42 percent) or strongly agreed (24 percent) that they would be interested in participating in a leadership development program if one were offered at their school. Students reported interest in improving their confidence, assertiveness, ability to communicate effectively (including public speaking), ability to listen to others, organizational skills, and ability to influence others. The results of this study suggest that many dental students are interested in developing leadership skills. Insights from this study can inform the design of leadership development programs.

Revisiting comfort: strategies observed in the direct observation study.

The Surgeon General's 2000 report on oral health found that one-third of adults in the U.S. had not visited a dentist in the previous year. Fear of treatments received during a dental encounter can create a barrier to patients receiving care. Most studies of dental anxiety have focused on phobic patients; relatively few studies have explored attempts to provide comfort and alleviate anxiety among everyday patients. This study describes comforting strategies that were performed by dentists, dental assistants, and hygienists for their patient population as a whole. As part of the Direct Observation Study, 120 dental practices in Ohio were observed over a four-day period by trained research hygienists. Researchers observed and recorded 3,800 patient interactions with dentists and hygienists at 30-second intervals using 24 behavior-specific codes. In addition, observers composed qualitative notes detailing the patient visits and recorded in their notes specific comforting techniques performed by dentists, hygienists, and dental assistants.

Patient receptivity to tobacco cessation counseling in an academic dental clinic: a patient survey.

OBJECTIVE: This study investigated dental patient attitudes towards tobacco cessation counseling in the dental school setting. METHODS: Patients attending an academic dental clinic during a six-week period were asked to complete a 22-item self-administered survey. Means and frequency distributions were assessed on all variables as appropriate. RESULTS: Response rate was 71%. Twenty-nine percent of respondents reported that they currently used tobacco. Seventy-two percent of tobacco users agreed that the student dentist should ask patients whether or not they use tobacco, 67% agreed that the student dentist should advise tobacco users to quit, and 89% agreed that student dentists should offer quit tobacco information to patients who want to quit. Seventy percent of tobacco users were considering quitting or currently trying to quit. Of these, only 31% were aware of community resources to help them quit. CONCLUSIONS: The majority of tobacco users were positive in their attitudes toward delivery of tobacco cessation counseling and services in the dental setting. Many were considering or trying to quit, but few were aware of community resources to help them.

Students' perceptions of effective learning experiences in dental school: a qualitative study using a critical incident technique.

Students' views of their educational experience can be an important source of information for curriculum assessment. Although quantitative methods, particularly surveys, are frequently used to gather such data, fewer studies have employed qualitative methods to examine students' dental education experiences. The purpose of this study is to explore characteristics of effective learning experiences in dental school using a qualitative method. All third-year (seventy) and fourth-year (seventy) dental students enrolled in one midwestern dental school were invited to participate. Fifty-three dental students (thirty-five male and eighteen female; thirty-two third-year and twenty-one fourth-year) were interviewed using a critical incident interview technique. Each student was asked to describe a specific, particularly effective learning incident that he or she had experienced in dental school and a specific, particularly ineffective learning incident, for comparison. Each interview was audiotaped. Students were assured that only the interviewer and one additional researcher would have access to the tapes. Data analysis resulted in identification of key themes in the data describing characteristics of effective learning experiences. The following characteristics of effective learning experiences were identified: 1) instructor characteristics (personal qualities, "checking-in" with students, and an interactive style); 2) characteristics of the learning process (focus on the "big picture," modeling and demonstrations, opportunities to apply new knowledge, high-quality feedback, focus, specificity and relevance, and peer interactions); and 3) learning environment (culture of the learning environment, technology). Common themes emerged across a wide variety of learning incidents. Although additional research is needed, the characteristics of effective learning experiences identified in this study may have implications for individual course design and for the dental school curriculum as a whole.

Early clinical experience for first-year dental students.

Over the past three years we have exposed our first-year dental students at Case Western Reserve University School of Dental Medicine to an early clinical experience. Following a seventy-two-hour didactic and laboratory course, first-year students spend over 100 hours treating school children in twenty-eight elementary and middle schools in the Cleveland Municipal School District. Not only do dental students learn a clinical procedure, but more importantly they experience the need for health care, in particular, dental care among those less fortunate than themselves. The experience strengthens their desire to help the under-served, their understanding of the problems many face in obtaining oral health care, and their commitment to addressing these issues. Themes from student reflection papers are summarized.

Attitudes of incoming dental students toward tobacco cessation promotion in the dental setting.

Dentists can play an important role in helping patients quit using tobacco. The aim of this study was to investigate incoming dental students' attitudes toward tobacco cessation promotion in the dental setting. Such attitudes can impact students' receptivity to training and subsequent involvement in tobacco cessation promotion. A twenty-six-item written survey was administered to freshman students at a midwestern dental school during orientation weeks 2002 and 2003. Questions focused on students' attitudes toward the dental professional's responsibilities and scope of practice in promotion of tobacco cessation. Response rate was 99 percent (139/140). Respondents were 75 percent male, 25 percent female. Mean age was 24.8 +/- 3.0 years. Ninety-nine percent agreed that it is the dental professional's responsibility to educate patients about the oral health risks of tobacco use. Eighty-five percent agreed that it is within the scope of dental practice to advise patients to quit using tobacco, but fewer agreed that it is within the scope of practice to discuss specific strategies for stopping (70 percent) or to prescribe nicotine gum (45 percent). Sixty-nine percent agreed that tobacco cessation counseling in the dental office could impact patients' quitting. Seventy-one percent anticipated that patient resistance could be a barrier to tobacco cessation promotion. Nearly one quarter (23 percent) were only slightly or not interested in receiving tobacco cessation training. Attitudes of incoming dental students appear to be positive regarding the dental professional's responsibility to educate patients about the risks of tobacco use. However, some students may have reservations about the extent to which tobacco cessation services fit within the scope of dental practice, the efficacy of such services, and patient receptiveness. These reservations should be addressed if dental school curricula in tobacco cessation are to be effective.