Online Dental Hygiene Degree Completion Program: Outcomes of a longitudinal study.

Purpose: Examining the long-term outcomes of education programs delivered online can help assess the impact of the program on graduates and the value of the delivery format. The purpose of this study was to measure the overall outcomes of an online dental hygiene degree completion program and identify key alumni outcomes.Methods: A 35 item electronic survey was delivered via email to all graduates (2009-2017) of an online degree completion program based in Ann Arbor, Michigan, two years following program completion. Survey items included Likert scale, closed and open-ended questions focusing on career characteristics, leadership, scholarly activities, evidence- and community-based practices, professional confidence, and transformative learning. Descriptive and inferential statistics were used to analyze the data.Results: Of the nine alumni cohorts (n=75), 50 graduates participated in the survey for a response rate of 67%. Eighty-two percent of respondents felt they had more career options after graduation and reported post-degree career activities that included dental hygiene instruction (36%), public health (32%), and administration (14%). There was a statistically significant increase in the instructor/educator role of the participants post-graduation (p = 0.000). The majority (94%) indicated the program improved their competency in areas of leadership and evidence-based practice and all (100%) indicated a greater responsibility to use their professional skills to address oral health disparities in their communitiesConclusion: Graduates of the online degree completion program reported ongoing activities in key areas of leadership, evidence- and community-based practice. Future research should focus on ensuring that program goals reflect the evolving dental hygiene profession and program delivery practices meet the needs of the working professional student.

Assessment of Michigan Dentists' and Dental Hygienists' Perceptions Toward Obtaining Continuing Education Credits for Volunteering in Community-Based Clinics.

Purpose: The purpose of this study was to assess dentists' and dental hygienists' current motivation, attitudes, and knowledge regarding volunteering in a non-profit dental setting and the opportunity for earning continuing education (CE) credits.Methods: This cross-sectional study surveyed a convenience sample of dental and dental hygiene professionals from the state of Michigan. A 20-question paper survey was developed and pilot tested. The survey was disseminated to attendees at various component meetings of the dental and dental hygienists' associations in southeastern Michigan.Results: Out of the 274 surveys that were distributed, 182 (n=182) were completed, yielding a 66% response rate. Eighty percent of the participants were unaware of the opportunity for earning CE by volunteering and 79% were unaware of the volunteering site approval requirement by the Michigan Board of Dentistry. Thirty percent of participants were unable to determine how many unpaid days per year they were willing to volunteer and a similar percentage, (28%), were unable to determine how many paid days. The most common motivating factor to volunteer was to give back to the community (60%) while the greatest barrier was lack of time (62%).Conclusion: The opportunity to earn CE credit for volunteerism is seen as a benefit, however, it needs to be better promoted to potential volunteers, through dissemination of information by professional associations and in educational settings. Community-based clinics also need to be made aware of how to become a CE provider. Further research on the longitudinal impact of CE for volunteerism in community-based clinics is warranted.

Dental Hygiene Students' Perceptions of Importance and Confidence in Applying Motivational Interviewing During Patient Care.

Purpose: Motivational Interviewing (MI) is an evidence-based, patient-centered counseling approach for eliciting behavior change. In 2012, the University of Michigan (U-M) Dental Hygiene Program significantly enhanced their behavior change curriculum by reinforcing and building upon the Motivational Interviewing segment. The purpose of this study was to examine students' perceptions of the importance of MI and their confidence in applying it during patient care.Methods: A convenience sample of 22 U-M Class of 2015 dental hygiene students who had received an enhanced curriculum participated in this study, utilizing a retrospective, pre-test/post-test design.Results: A Wilcoxon signed rank test was used to compare the differences in average ranks between T1 (Retrospective Pre-Test) and T4 (Post-Test 3) for the importance and confidence questions at each time point for the Class of 2015. Students' perceptions of importance increased with statistical significance in five out of eight MI strategies. Perceptions in confidence increased in seven out of eight strategies. Effect size ranged from .00 to .55. Assessment of qualitative data provided additional insight on student experiences.Conclusion: Student perceptions of importance of using MI and their confidence in applying MI increased in a majority of the strategy categories. Successes with patient health behavior change and challenges with time to integrate this in practice were noted. Research on the longitudinal impact and faculty feedback calibration is recommended.

Factors Associated with the Economic Sustainability of the Registered Dental Hygienist in Alternative Practice.

Purpose: The purpose of this study was to investigate key factors associated with the economic sustainability of the Registered Dental Hygienist in Alternative Practice (RDHAP).Methods: An invitation to participate in a 38-question electronic survey was sent via postal mail to 440 RDHAP licentiate addressees obtained through the Dental Hygiene Committee of California (DHCC). Legal restrictions did not allow for obtaining the RDHAP licentiate email addresses from the DHCC. The survey was disseminated via email to the 254 RDHAPs who were members of the California Dental Hygienists' Association. Additional invitations to participate were made via flyer distribution at an RDHAP symposium, and on RDHAP only social media sites.Results: The response rate was an estimated 16%. While 44% of the RDHAPs reported some employment in a traditional dental practice, given the opportunity, 61% of these respondents indicated that they would practice exclusively as an RDHAP. With regard to practice strategic planning and alliances, 31% felt that dentists lacked knowledge of the RDHAP, and 25% indicated dentists were resistant to this workforce model. Regarding RDHAP practice staffing patterns, 75% indicated not having any employees. When asked about business systems, 64% had solo, portable practices and 16% had standalone practices. Economic sustainability challenges included practice business/equipment expenses (29%), insurance/reimbursement issues (21%), patient flow (19%) and RDHAP visibility (14%).Conclusions: RDHAP practices face challenges including the need for strategic planning and intra- and inter-professional alliances, efficient and effective patient flow, optimal staffing patterns and effective business systems. Focus on enhancing RDHAP visibility within the dental and medical communities should be a priority. In addition, further research should explore RDHAPs aligning with community-based clinics, Federally Qualified Health Centers and Dental Support Organizations (DSOs) with a commitment to disease prevention in addition to the financial resources and staff to manage practice business systems.

Effect of Faculty Development Activities on Dental Hygiene Faculty Perceptions of and Teaching About Motivational Interviewing: A Pilot Study.

The aims of this pilot study were to assess dental hygiene faculty members' perceptions of the importance of motivational interviewing (MI) and their confidence in teaching students about MI and to determine the effect of MI training sessions on those perceptions. Participants were a convenience sample of all 16 dental hygiene faculty members who teach in the clinic at the University of Michigan School of Dentistry. Participants' perceptions were assessed prior to a workshop in MI (pretest), immediately after the workshop (posttest 1), and eight months after the workshop, at the end of the academic year (posttest 2). During the same period, some of the workshop participants took part in team grading sessions of audio recordings of student-patient MI interactions. The results showed that the majority of the faculty members perceived it was important to personally embrace the overall spirit of MI during patient care, and they were confident supporting students as well. Their ratings for embracing the spirit of MI increased from pretest to posttest 1, but slightly decreased at posttest 2. This trend was also seen in their assessment of the importance of and their confidence in teaching the eight MI strategies over time. Among the workshop participants, 56% were part of team grading; they reported the most helpful professional development activities overall were team grading (58%) and the workshop (25%). These results suggest the importance of making use of a variety of faculty development activities and of introducing appropriate follow-up to training sessions over time to ensure long-lasting effects. Future research using carefully designed, multi-institution, longitudinal studies is needed to determine the most effective ways to prepare dental hygiene faculty members to educate their students about MI.

Assessing the Use of Loupes and Lights in Dental Hygiene Educational Programs.

Purpose: The purpose of this study was to explore the use of loupes and lights in dental hygiene programs, to assess why they are being used, and to evaluate at what point in time they are introduced to students within the curriculum.Methods: A 20 question survey was developed and pilot tested. The survey was disseminated electronically to 335 dental hygiene program directors in the United States. Frequency distributions were analyzed to provide an overview of the data and Fisher's Exact Test was used to investigate differences between technical/community college programs and university-based programs.Results: Out of the 335 electronic surveys, 143 were completed for a response rate of 47%. Prevention of musculoskeletal disorders, ergonomics, and enhanced vision for instrumentation remain the top three advantages of using loupes. Ninety-six percent of respondents indicated students use loupes and over 50% of faculty use loupes. Fifty-seven percent of dental hygiene programs encourage students to purchase loupes with a light. Fifty percent of students pay $601-$900 for loupes and 47% pay $300-$600 for a light.Conclusion: Student and faculty use of loupes and lights are increasing in educational programs. Future research should focus on the longitudinal impact of using loupes/lights, the prevention of musculoskeletal disorders, and an investigation of the continued use of loupes in a professional setting post-graduation.

Measuring Curricular Impact on Dental Hygiene Students' Transformative Learning.

Previous research has suggested that transformative learning can be fostered in higher education by creating active learning experiences that are directly related to content taught, are personally engaging, and can stimulate reflection. The aim of this qualitative study was to assess changes experienced by students in an e-learning dental hygiene degree completion program beyond attainment of competence-changes that may be described as transformative learning. The data used were transcripts of focus groups that had been conducted with each of the first five cohorts of students to graduate from the program; a total of 30 of the 42 students in the five cohorts (71%) participated. Using their previously developed Transformation Rubric for Engaged Learning, the authors categorized focus group data to identify changes in students' confidence, pride, skills, perceptions of the world, and personal identity at the transformative and nontransformative levels. Every participant reported at least one change; overall, the students averaged 8.3 changes. The vast majority (84%) of these changes were transformative. Middle-performing students showed a disproportionately higher rate of transformational changes in the areas of confidence and pride. The e-learning program appeared to have had a significant transformative impact on students, but additional research on the effect on middle-performing students is warranted.

Interprofessional Education in U.S. Dental Hygiene Programs: A National Survey.

Although there are many benefits of interprofessional health care, no previous research has sought to define the status of interprofessional education (IPE) in U.S. dental hygiene programs. The aims of this study were to assess how these programs engage in IPE, the challenges they encounter, and the value they place on IPE. Additionally, the study explored how program characteristics are related to IPE. Data were collected with a web-based survey sent to all 322 U.S. dental hygiene program directors (response rate: 33% of the 305 successfully contacted). The majority of the responding programs were located at institutions with nursing (90%) and other allied health programs (85%). They were likely to collaborate with nursing (50%), other allied health (44%), and dental assisting programs (41%), but were less likely to collaborate with dental schools (28%). IPE was most likely to occur in volunteer activities (68%), basic science courses (65%), and communication training/behavioral science courses (63%/59%). The most frequently reported challenges for IPE were schedule coordination (92%) and curriculum overload (76%). The majority of the respondents agreed that IPE was a priority for the dental hygiene profession in the U.S. (59%) and for the program directors personally (56%). Programs granting bachelor degrees were more likely to have IPE as a priority than programs that did not grant such degrees (scale of 1-5 with 5=most important: 3.81 vs. 2.88; p<0.01). The longer the students spent in the programs, the more those programs engaged in IPE (r=0.21; p<0.05). The data collected in this study can contribute to future efforts to help dental hygiene programs engage in meaningful IPE and contribute to developing interprofessional care in the U.S. health care system.

The Origins of Minnesota's Mid-Level Dental Practitioner: Alignment of Problem, Political and Policy Streams.

PURPOSE: Using John Kingdon's agenda-setting model, this paper explores how Minnesota came to legislate a mid-level dental practitioner to its oral health workforce. Using a pluralist framework embracing the existence of various interests and convictions, this analysis highlights the roles of issue formation, agenda setting and politics in policymaking. METHODS: Using Kingdon's agenda-setting model as a theoretical lens, and applying case study methodology, this paper analyzes how Minnesota came to legislate a mid-level dental practitione to its oral health workforce. Data have come from scholarly research, governmental and foundation agency reports, interviews with leaders involved in the mid-level dental practitioner initiative, news articles, and Minnesota statute. RESULTS: After 2 years of contentious and challenging legislative initiatives, the problem, policy and political streams converged and aligned with the compromise passage of a bill legalizing mid-level dental practitioner practice. The Minnesota Dental Therapist Law was the first-in-the-nation licensing law to develop a new dental professional workforce model to address access to oral health care. CONCLUSION: The Minnesota mid-level dental practitioner initiative demonstrates the important convergence and alignment of the access to oral health care problem and the subsequent collaboration between political interest groups and policymakers. Through partnerships and pluralist compromise, mid-level dental practitioner champions were able to open the policy window to move this legislation to law, enhancing the oral health workforce in Minnesota.

Safety Net Care and Midlevel Dental Practitioners: A Case Study of the Portion of Care That Might Be Performed Under Various Setting and Scope-of-Practice Assumptions.

OBJECTIVES: We sought to determine the proportion of dental care provided at safety net-type clinics that might be performed by midlevel practitioners. METHODS: Data were obtained on 157,328 procedures performed in 2012 at the clinics associated with a Midwestern dental school. Based on procedure codes, we determined the overall proportion, as well as the proportion of visits and patients' care, that could have been performed by 3 types of practitioners. RESULTS: Overall, 48% to 66% of all procedures could have been performed by a midlevel dental practitioner. Nearly half of all visits, and roughly a third of all patients, could have been entirely cared for by a practitioner trained in prophylaxis and with evaluation capabilities. Such practitioners could handle roughly 80% of the visits at the community-based clinic and more than half of the visits at the hospital-based clinic. CONCLUSIONS: A midlevel practitioner with training in prophylaxis has the potential to alleviate much of the burden on the dental safety net because much of the need among vulnerable populations falls well within their scope of practice.

The origins of Minnesota's mid-level dental practitioner: alignment of problem, political and policy streams.

PURPOSE: Using John Kingdon's agenda-setting model, this paper explores how Minnesota came to legislate a mid-level dental practitioner to its oral health workforce. Using a pluralist framework embracing the existence of various interests and convictions, this analysis highlights the roles of issue formation, agenda setting and politics in policymaking. METHODS: Using Kingdon's agenda-setting model as a theoretical lens, and applying case study methodology, this paper analyzes how Minnesota came to legislate a mid-level dental practitione to its oral health workforce. Data have come from scholarly research, governmental and foundation agency reports, interviews with leaders involved in the mid-level dental practitioner initiative, news articles, and Minnesota statute. RESULTS: After 2 years of contentious and challenging legislative initiatives, the problem, policy and political streams converged and aligned with the compromise passage of a bill legalizing mid-level dental practitioner practice. The Minnesota Dental Therapist Law was the first-in-the-nation licensing law to develop a new dental professional workforce model to address access to oral health care. CONCLUSION: The Minnesota mid-level dental practitioner initiative demonstrates the important convergence and alignment of the access to oral health care problem and the subsequent collaboration between political interest groups and policymakers. Through partnerships and pluralist compromise, mid-level dental practitioner champions were able to open the policy window to move this legislation to law, enhancing the oral health workforce in Minnesota.

Assessment of women, infants and children providers' perceptions of oral health counseling and availability of associated resources.

PURPOSE: Children from low-income families and ethnic minority groups are associated with an increased risk of developing dental disease and are often enrolled in the Women, Infants and Children (WIC) nutritional program. It has been an intention of the Michigan Department of Community Health (MDCH) Oral Health Program (OHP) to collaborate with WIC to provide preventive oral health resources and education to their population. This project focused on achieving the goals outlined in the Michigan 2010 State Oral Health Plan. METHODS: An 18 question survey was designed to identify gaps existing in oral health counseling in Michigan WIC agencies. The survey was disseminated to 56 MI WIC agencies. RESULTS: WIC providers perceive oral health risk assessment to be important and are asking oral health questions during certification and re-certification appointments. Seventy-nine percent of participants indicated they never had training in oral health counseling, and 79% are interested in learning more about oral health. Agencies are interested in obtaining oral health education resources for their clients. CONCLUSION: The 2010 State Oral Health Plan's goals recognized the need for oral health related resources and education within community-based programs like WIC. The results of the survey support the need for additional oral health counseling and associated resources in WIC agencies. This information will be used to help the MDCH OHP find ways to address these gaps.

Recruiting underrepresented minority and low-income high school students into dentistry while educating dental and dental hygiene students about academic careers.

The objectives of this project were to create a program that would expose underrepresented minority (URM) and low income (LI) high school students to dental professions and provide an opportunity for dental and dental hygiene students from URM/LI groups to be engaged in teaching activities. Data were collected from participants during the school years 2009-10 (high school students: N=23, dental students: N=21, dental hygiene students: N=5) and 2010-11 (N=27, N=11, N=3, respectively). The students participated in fifteen Saturday sessions from October through March each year. The data showed that, from the beginning, mentees and mentors were very interested in participating in the program and getting to know each other. Lectures, general program activities, and patient-related events such as organizing a health fair and shadowing during two outreach clinics were evaluated positively by mentees and mentors. The end of program evaluations showed that the program and the mentee-mentor relationships were rated very positively and that the mentees had an increased interest in oral health-related careers. In conclusion, creating opportunities for URM/LI high school students to explore dental careers and for dental and dental hygiene students to engage in teaching resulted in positive experiences for both groups.

ePortfolio: developing a catalyst for critical self-assessment and evaluation of learning outcomes.

There is a growing trend among college accreditation bodies, especially in professional schools, to incorporate self-assessment in the curriculum and deliver evidence of students' learning outcomes. Both as product and process, reflective ePortfolios have the potential to promote learning and transfer of knowledge by fostering the ability to make connections between learning outcomes and leaning experiences. This article describes a model for a program-wide integrated reflective ePortfolio developed by the University of Michigan Dental Hygiene Degree Completion E-Learning (online) Program. This systematic approach to developing a successful portfolio program can be utilized in many areas of professional health care education. Applying these strategies can result in an ePortfolio that has a positive impact on student learning, develops reflective practitioners, and provides valuable programmatic outcomes data.

Using multiple methods to assess learning and outcomes in an online degree-granting dental hygiene program.

Program evaluation is a necessary component of curricular change and innovation. It ascertains whether an innovation has met benchmarks and contributes to the body of knowledge about educational methodologies and supports the use of evidence-based practice in teaching. Education researchers argue that rigorous program evaluation should utilize a mixed-method approach, triangulating both qualitative and quantitative methods to understand program effectiveness. This approach was used to evaluate the University of Michigan Dental Hygiene Degree Completion E-Learning (online) Program. Quantitative data included time spent on coursework, grades, publications, course evaluation results, and survey responses. Qualitative data included student and faculty responses in focus groups and on surveys as well as students' portfolio reflections. The results showed the program was academically rigorous, fostering students' ability to connect theory with practice and apply evidence-based practice principles. These results also demonstrated that the students had learned to critically reflect on their practice and develop expanded professional identities; going beyond the role of clinician, they began to see themselves as educators, advocates, and researchers. This evaluation model is easily adaptable and is applicable to any health science or other professional degree program. This study also raised important questions regarding the effect of meta-reflection on student confidence and professional behavior.

Using online program development to foster curricular change and innovation.

Distance education offers an opportunity to catalyze sweeping curricular change. Faculty members of the University of Michigan Dental Hygiene Program spent eighteen months researching best practices, planning outcomes and courses, and implementing an e-learning (online) dental hygiene degree completion program. The result is a collaborative and portfolio-integrated program that focuses on the development of reflective practitioners and leaders in the profession. A team-based, systems-oriented model for production, implementation, and evaluation has been critical to the program's success. The models and best practices on which this program was founded are described. Also provided is a framework of strategies for development, including the utilization of backward course design, which can be used in many areas of professional education.

Assessment of the University of Michigan's dental hygiene partnership with the Huron Valley Boys & Girls Club: a study of students' and staffs' perceptions and service learning outcomes.

PURPOSE: The Boys & Girls Club of America (BGCA) requires a health curriculum be taught. With the assistance of the University of Michigan (UM) Dental Hygiene program, these requirements have been addressed at the Huron Valley Boys & Girls Club (HVBGC) through dental hygiene students presenting oral health education to club members throughout the year. This study assessed the outcomes and benefits of the service learning initiative between the UM Dental Hygiene Program and the HVBGC from both the students' and staffs' perceptions. METHODS: Three surveys were distributed: one to the HVBGC staff, one to UM's Dental Hygiene class of 2012 (with no service learning experience at the HVBGC) and one to UM Dental Hygiene classes of 2010 and 2011 (most of whom had experience at the HVBGC). Qualitative and quantitative data were collected and evaluated. RESULTS: The respondents from the class of 2012 were less knowledgeable about the BGCA and access to care issues. The members of the classes of 2010 and 2011, 79% of whom had HVBGC experience, identified they had benefitted from this service learning experience. The HVBGC staff survey indicated a high level of satisfaction with the student presentations and felt their curricular requirements were being met. Future topics of safety, orthodontics and gardening/nutrition were identified. CONCLUSION: This study indicates the service learning initiative has been beneficial for both the UM Dental Hygiene students and the HVBGC. Future studies should use a longitudinal design to obtain baseline and post-service learning data.

Online directed journaling in dental hygiene clinical education.

Reflecting upon and sharing of clinical experiences in dental hygiene education is a strategy used to support the application of didactic material to patient care. The promotion of interactive, clinically focused discussions creates opportunities for students to foster critical thinking and socialization skills in dental hygiene practice. Twenty-eight dental hygiene students in their first semester of patient care utilized online directed journaling via blogging software, as a reflection and sharing strategy. Journal entries found critical thinking and socialization themes including connection of didactic material to clinical experience, student-patient interaction, student-student collaboration, and a vision of the professional role of the dental hygienist. A 7 item evaluation instrument provided data that the online journaling strategy was perceived as effective and valuable by the students. Online directed journaling is a strategy that has the potential to enhance critical thinking and socialization skills in dental hygiene clinical education.

The utilization of Computer Mediated Communication for case study collaboration.

Computer Mediated Communication (CMC) can be used as an effective tool for student communication and collaboration. First-year, first-semester dental hygiene students self-selected groups to develop dental hygiene process of care treatment plans, written reports, and oral case presentations based on assigned clinical cases. In consultation with the University of Michigan (UM) Digital Media Commons Collaborative Technologies Teams, CMC options were identified. Two chat rooms were established within the UM's Course Management System (CTools) to provide opportunities for synchronous (simultaneous, real-time) communication. One course blog site and 8 case blog sites were developed to provide students and instructors with electronic asynchronous (nonsimultaneous) communication formats. The purpose of this study was to evaluate the effectiveness of these technologies during group case study projects. CMC has the potential to provide an effective means of collaboration and communication when the technologies align with the purpose of the project and compliment the dynamics of student groups.