Developing entrustable professional activities for general dentistry at the University of North Carolina.

INTRODUCTION: As part of curriculum innovation, the University of North Carolina (UNC) Adams School of Dentistry identified core entrustable professional activities (EPAs) that graduates must demonstrate for practice readiness. This paper describes the development of the UNC EPAs and the perceptions of the general dentistry faculty. METHODS: Upon establishing a blueprint of knowledge, skills, and attitudes of UNC graduates, using a distributed leadership approach, faculty teams developed EPAs focused on the patient care process. The American Dental Education Association Compendium of Clinical Competency Assessments and Commission on Dental Accreditation Standards informed the team's work. Perceptions of the assessment framework were examined using a questionnaire completed by 13 general dentistry faculty considering the importance, accuracy, and agreement of each EPA, associated domains of competence, and encounter management on a 6-point rating scale. RESULTS: Distributed leadership was a useful strategy in EPA development to disperse decision-making and build ownership. Through multiple iterations, four EPAs (assessment, plan of care, collaborative care, and provision of care) with associated sub-EPAs emerged. EPAs included a description, required knowledge and skills, and rubrics for assessment. The general dentistry faculty reported a high level of importance, accuracy, and agreement with EPAs, domains of competence, and encounter management. DISCUSSION: EPAs provide a standardized manner to describe the comprehensive work dentists perform, shifting away from individual competencies. The UNC EPAs provide the foundation for longitudinal measures of competence preparing graduates for independent practice. With limited EPAs frameworks available in dentistry, we aim to inform the development and implementation of EPAs across dental education.

Preparing Primary Care Registered Nurse Preceptors for Emerging Care Coordination and Chronic Disease Self-Management Roles.

Nurse educators must prepare the future RN work-force to practice in emerging primary care roles. This program evaluation report describes the approach taken to develop and evaluate a novel preceptor education program designed to prepare RNs to precept nursing students in primary care coordination and disease self-management roles. The program was designed as a three-stage hybrid learning intervention with the goals of preparing RNs to (a) provide primary care coordination and disease self-management support and (b) precept nursing students. Evaluation tools were designed to reflect specific learning objectives of these goals pre- and postintervention. Preliminary evaluation data indicate the preceptor program provided a useful set of educational activities to prepare primary care RN preceptors for their new roles. Participants reported increased confidence levels in primary care coordination and disease self-management and student precepting responsibilities. Nursing students' evaluations showed positive primary care clinical experiences. [J Contin Educ Nurs. 2023;54(10):454-461.].

Working collaboratively across schools to promote oral health education through interprofessional education.

PURPOSE: The Association of American Medical Colleges and American Dental Education Association have identified oral health knowledge, skills, and attitudes shared by both medical and dental professionals. Although oral health was deemed an essential competency for medical practitioners, our state struggled to ensure learners received proper training. This training deficit resulted in conducting a needs assessment and implementing an oral health interprofessional module at our schools. METHODS: First-year medical students and clinical faculty were emailed surveys in 2016 to obtain baseline information. A team of faculty and students from the Schools of Medicine and Dentistry reviewed the curriculum to determine where to augment oral health content. An oral health module to teach a basic head, neck, and oral examination to first-year medical students during their patient-centered care small-group sessions was implemented and evaluated. RESULTS: Only 13.6% of faculty respondents were aware of national oral health competency recommendations, and <50% rated oral health important for primary care physicians (PCPs) to include in history, physical exam, or oral health counseling. On baseline, ≤25% of PCP respondents reported integrating the listed skills in their practice, and most indicated lacking expertise to teach oral health. Teaching sessions were rated helpful by students and faculty. After the teaching sessions, ratings on the importance of including oral health significantly increased from baseline. CONCLUSION: Collaboration between Schools of Dentistry and Medicine successfully integrated oral health into medical school curriculum and improved the tutors' attitudes of its importance.

Audiology and oral health professional students: An interprofessional education collaboration.

OBJECTIVES: Audiology knowledge is important for oral health professionals because patients may present with hearing loss or temporomandibular joint dysfunction with referred pain to the ear. Additionally, their occupational environment may negatively affect their own hearing. An interprofessional learning experience for dental (DDS), dental hygiene (DH), and audiology students was created to increase DDS and DH students' knowledge of the audiology profession, risks to their own hearing, and communication with hearing-impaired patients. This study's purpose was to evaluate this new educational experience. METHODS: In 2018, audiology students presented information to DH and DDS students about audiology and offered optional supervised hearing screenings. DDS and DH students were surveyed to assess their self-rated knowledge level on audiology topics (e.g., audiology profession, hearing assessment, noise-induced hearing loss, and communicating with hearing impaired patients) before and after the educational sessions, as well as to evaluate their learning experience. Audiology students received didactic and hands-on instruction by DDS and DH students and faculty on performing a head and neck exam and making appropriate referrals. RESULTS: The response rate was 48% (n = 57). Students' reported knowledge on all topics significantly improved (P < 0.05) after the educational program. The majority, 86%, agreed that this experience should be added to the curriculum, and 92% reported it increased their understanding of the importance of collaborating with other health professionals. CONCLUSIONS: This experience increased students' knowledge of the audiology profession and understanding of hearing loss, while also increasing their appreciation of interprofessional education.

Development of a Dental School Strategic Plan to Inform Interprofessional Education.

Changes in U.S. health care delivery systems and Commission on Dental Accreditation standards provide impetus for interprofessional education (IPE) and collaborative practice, but roadmaps for engaging dental and dental hygiene faculty to incorporate IPE in a systematic manner are limited. The purpose of this report is to describe the process for creating a strategy and gathering a variety of baseline data to use for determining objectives and metrics and the subsequent development of an IPE strategic plan at the University of North Carolina (UNC) at Chapel Hill Adams School of Dentistry (SOD). SOD IPE committee members included representation from the UNC Schools of Dentistry, Medicine, Pharmacy, and Business. A three-phase framework was developed. Phase 1 (IPE assessment) was an internal environmental scan including a 2017 faculty survey, departmental mapping of IPE activities, comparison of UNC with national results on the IPE component of the American Dental Education Association (ADEA) survey of dental school seniors (2016 graduating class), identification of faculty joint/adjunct appointments at other UNC schools, and a strengths, weaknesses, opportunities, threats (SWOT) analysis. Phase 2 (visioning) consisted of development of IPE mission, vision, and priorities. In Phase 3 (implementation), priorities were developed. Data-gathering led to a strategic plan with three objectives: 1) increase faculty engagement and recognition, 2) develop predoctoral dentistry and dental hygiene IPE curricula, and 3) develop an infrastructure that supports IPE. Specific initiatives and activities, supporting metrics, and estimated costs were developed for each objective. The framework guided a systematic, transparent, and organized process for collecting and monitoring the evidence and directing activities. A three-year strategic plan for IPE was developed in 2017, and implementation is ongoing.

Assessing Dental Students' Knowledge, Attitudes, and Beliefs About Medicaid and Health Care Reform: A Mixed-Methods Study.

The aim of this study was to conduct a needs assessment of Medicaid and health care reform education in the current dental curriculum of one U.S. dental school. A mixed-methods approach was employed using focus groups and surveys. Three focus groups with dental students (nine first-and second-year students, eight third-year students, and seven fourth-year students) and one focus group with six external oral health stakeholders were conducted in 2018 to explore participants' attitudes and beliefs about Medicaid and health care reform. The focus groups used a semi-structured guide, and transcripts were analyzed using thematic content analysis. Following the focus groups, all first-and fourth-year dental students were invited to participate in a survey assessing their general and dental-specific Medicaid knowledge and attitudes about Medicaid. In both methods, participants made suggestions for future curricular experiences involving Medicaid. Surveys were returned from 81 first-year students (96% response rate) and 72 fourth-year students (86% response rate), for an overall response rate of 93%. Participating students and stakeholders agreed that Medicaid is confusing and challenging to incorporate into private practice. All participants viewed programs sponsored by organized dentistry as venues to learn about oral health policy. Nearly all participants agreed that private practice mentorship, improved practice management, and more experiential opportunities in the predoctoral curriculum would be effective strategies to increase knowledge about Medicaid and health reform. According to the survey responses, Medicaid and health reform knowledge is poor and scarcely covered in the current curriculum, and only 39% of participating students planned to participate in Medicaid after graduation. These findings suggest that curricular improvements are needed to incorporate more engaging and experiential learning using external resources.

Call for ACTion: Transforming Dental Education at the University of North Carolina at Chapel Hill.

The University of North Carolina at Chapel Hill Adams School of Dentistry is developing a transformative curriculum that prepares students to enter contemporary practice. The Advocate, Clinician, and Thinker (ACT) framework will provide the basis for developing a resilient workforce capable of meeting emerging health care needs over the next 40 years.

Collaborative Educational Experiences of Dental Hygiene and Audiology Students.

Purpose: An innovative, collaborative interprofessional experience for dental hygiene and audiology students that included hearing assessments and a class lecture/discussion session was developed and implemented at the University of North Carolina, Chapel Hill. The purpose of this study was to evaluate whether the objectives were met for the initial educational experience and to identify areas for improvement.Methods: Audiology students, under faculty supervision, provided hearing screenings for 33 senior dental hygiene (DH) students and 4 graduate (DHE) students. In a subsequent didactic session for the DH and DHE students, an audiology doctoral student presented on the following topics: overview of the audiology profession, interprofessional collaboration with audiologists, principles of noise-induced hearing loss, protective measures for hearing health, and techniques for communicating with patients with hearing loss. Class discussion followed the lecture presentation. Surveys on the screening and education session were completed by the students and changes in their perception of knowledge were assessed.Results: Nearly half (49%) of the students indicated that this was their first hearing assessment. The vast majority (97-100%) agreed or strongly agreed that the experience was well-organized, contained important information for dental practice, and increased their understanding of the importance of collaboration and their comfort level in working with audiologists. Nearly all of the students (94%) recommended this experience be included in future curriculum. Significant changes were reported in students' knowledge of hearing assessments, noise induced hearing loss, and communication with patients with hearing loss (Wilcoxon Signed Rank Test, p < 0.05).Conclusion: The educational objectives of this initial interprofessional collaborative experience were met. Participants reported that the didactic and experiential education was a valuable learning experience and it increased their knowledge about the audiology profession and hearing health for themselves and their patients.

Interprofessional Education: Oral Health in the Medical Curriculum.

Schools of medicine and dentistry on the same geographical campus have an opportunity to promote oral health by training physicians to become more skilled in screening for oral disease in addition to counseling and referring patients to dental health professionals.

Bridging the Gender Divide: Facilitating the Educational Path for Men in Nursing.

BACKGROUND: Although the number of men entering the nursing profession over the past century has increased incrementally, the proportion of men remains low in contrast to the U.S. POPULATION: On matriculation into nursing school, men face stereotypes about the nursing profession and the characteristics of the men who enter it. Men may also face a number of gender-based barriers, including lack of history about men in nursing, lack of role models, role strain, gender discrimination, and isolation. METHOD: This article describes each of these barriers and provides strategies to improve male students' learning experience. RESULTS: The efforts of one nursing school to address many of these barriers are also described. CONCLUSION: Through acknowledging gender barriers and taking intentional steps to address them with prenursing and nursing students, schools of nursing may create a more inclusive environment and enhance the profession's diversity. [J Nurs Educ. 2017;56(5):295-299.].

Development and Assessment of Discrimination Exercises for Faculty Calibration in Preclinical Operative Dentistry.

The aims of this study were to identify the level of interexaminer agreement among preclinical operative dentistry faculty members when grading Class II preparations performed by first-year dental students; to develop discrimination exercises for specific preparation components where interexaminer agreement was poor; and to evaluate if the discrimination exercises were able to improve inter- and intraexaminer agreement. In the preliminary phase of this study, 13 components of 32 Class II cavity preparations were assessed by eight course faculty members at one U.S. dental school. Analysis of average interexaminer agreement on these components revealed that six were below 60%. These were proximal contact clearance, retention groove placement, retention groove depth, preparation walls, preparation margins, and preparation toilet/debris. A 30-minute calibration session was subsequently developed to provide discrimination exercises utilizing 3-D models and digital images of various levels of student performance for five of the six components. Immediately following calibration, the course faculty assessed the same 32 preparations (Phase I) followed by a delayed assessment without calibration (Phase II) approximately six months later. The results showed that overall interexaminer reliability improved after calibration. Although there was a decline in interexaminer reliability after an interval of six months (Phase II), the degree of variation among examiners was lower than in the preliminary assessment. These findings support the use of discrimination exercises for preclinical operative dentistry course faculty to increase interexaminer agreement and thereby improve the consistency of faculty-student communication.

Faculty development: doing more with less.

Faculty development is essential to prepare novice nurse educators for their teaching role and to keep experienced faculty up to date with new educational approaches. This article describes a comprehensive and cost-effective program for faculty development that builds on the expertise of current faculty to educate, guide, and support colleagues, and foster their career development. The faculty development program includes an annual clinical faculty workshop; monthly face-to-face and online educational programs; a formal mentoring program for novice teachers and faculty members new to the school; programs for professional and career development; and a website for faculty orientation and continued learning.

Development of a scripted unfolding case study focusing on delirium in older adults.

This article describes the process of developing and implementing a scripted unfolding case study about delirium as part of a continuing education program for nursing staff. This innovative instructional strategy allows learners to evaluate a situation as it unfolds, practice assessment and communication skills, and reflect on potential problems and solutions. Using the detection and treatment of delirium as an example, the authors describe a template for developing a low-cost, low-fidelity case simulation that includes identifying the key concepts and competencies; writing behavioral learning objectives; creating the story; and identifying clinical decision-making points for discussion. Positive evaluations by program participants (registered nurses, licensed practical nurses, and nursing assistants) indicate that this methodology encourages interactive learning of key concepts in geriatric nursing among participants with varying years of experience.

Development and dissemination of Web-based clinical simulations for continuing geriatric nursing education.

This article describes the process of developing and disseminating a Web-based library of geriatric clinical simulations used in continuing education workshops. Twenty-six peer-reviewed clinical simulations were developed on topics reflecting prevalent acute illnesses, conditions, or sentinel events that, if left undetected or untreated, could cause further comorbidity, hospitalization, or death. Geriatric nursing competencies identified by The John A. Hartford Foundation Institute for Geriatric Nursing were also incorporated. More than 700 workshop attendees and others have used these online clinical simulations. User evaluations of realism, accuracy of the situation or problem portrayed, and relevance to practice were rated as excellent or very good by more than 85% of the users. The University of North Carolina at Chapel Hill Center for Lifelong Learning Web site will offer this library with associated American Nurses Credentialing Center contact hours. This online access provides nurses high-quality continuing education offerings to increase knowledge and improve competence in the care of aging adults.

Causative factors affecting peripheral neuropathy in burn patients.

Peripheral neuropathy in burn patients may be frequently missed in clinical settings. Although its incidence has been reported, little is known regarding the factors that cause burn-related peripheral neuropathy. A retrospective chart review of the demographic and clinical characteristics of patients admitted to a university hospital based burn center was conducted to explore the characteristics of burn-related neuropathy and factors affecting its types or extent. The variables collected were gender, age, length of hospital stay, site and surface area of burn, type of burn, and electrodiagnostic findings. We found that flame injuries, and third degree injuries were the most common in patients with peripheral neuropathy. Axonotmesis was more common than demyelinating injury and polyneuropathy was more common than mononeuropathy. Higher degree and larger area burns were more frequently associated with axonotmesis than with demyelination. Length of hospital stay was significantly longer in patients with axonotmesis. Overall, more severe burns showed a significant association with axonotmesis and a tendency to be related to polyneuropathy.

Using clinical simulations in geriatric nursing continuing education.

Accompanying an increased number of older adults in the population is the need for knowledgeable and clinically competent nurses to provide care for this group, especially those experiencing sudden changes in health status. A continuing education program was designed to improve geriatric nursing competencies through the use of clinical simulations. Three-day nurse educator institutes and one-day workshops for registered and licensed practical nurses were offered to 312 nurses. The clinical simulations that were developed specifically focused on acute health events or conditions. Specific geriatric clinical competencies were also emphasized. Different types of clinical simulations included unfolding cases, use of a human patient simulator, and online case studies. Geriatric nursing knowledge significantly increased and clinical simulations were well-received. Clinical simulations involving the human patient simulator were highly rated. Clinical simulations are an excellent teaching strategy to help nurses increase knowledge and skill in caring for older adults.

Evidence-based and population-based medicine: national implementation under the UME-21 project.

BACKGROUND AND OBJECTIVES: The Undergraduate Medical Education for the 21st Century (UME-21) project developed and implemented innovations to medical school curricula at medical schools across the country. This report describes the development and implementation of innovative approaches to improving instruction in evidence-based medicine with a population-based perspective. METHODS: Each school participating in the UME-21 project designed, implemented, and evaluated its own unique curriculum initiatives. We examined these initiatives using data abstracted from written reports submitted to the project Executive Committee. Additional data were obtained by personal communication with project directors and evaluators at the various schools, student and preceptor comments, internal program evaluation at each school, and external evaluation by the UME-21 project leadership. The Association of American Medical Colleges Graduation Questionnaire was also used. RESULTS: Fourteen of 18 participating schools implemented a broad range of curricula to facilitate teaching and learning about evidence-based and population-based medicine. Common themes included the application of evidence to patient care, use of clinical practice guidelines and pathways, and the general incorporation of evidence-based techniques (literature searching, critical appraisal, etc) into the teaching of other content, such as clinical science and managed care. Teaching approaches included Web-based and other computer-based education, an emphasis on active and self-directed learning, use of small groups and workshops, and distribution of this content over multiple years. As an alternative to full-length evidence-based medicine courses, many schools incorporated an evidence-based approach into existing courses and clerkships. Data demonstrated an upward trend in student satisfaction with how topics were presented at UME-21 schools. CONCLUSIONS: These innovations successfully demonstrated that evidence-based and population-based medicine content can be introduced into medical school curricula. Introducing these constructs in ways that demonstrate their relevance to patient care facilitates student learning.

Behavioral coding for evaluation of medical student communication: clarification or obfuscation?

PURPOSE: To understand which specific student behaviors predict performance ratings from standardized patients and behavioral scientist preceptors. METHOD: In 1996-98, objective, real-time ratings of student verbal and nonverbal behaviors were conducted on 75 videotaped interviews between second-year medical students and standardized patients at University of North Carolina at Chapel Hill School of Medicine. The coding system used in these analyses was developed based on evidence-based literature reviews and used software that provides for real-time recording; 30 nonverbal and 33 behaviors were coded. The coded behaviors were then compared with four ratings: a global rating of the encounter by the standardized patient, a summary score derived from a checklist completed by the standardized patient, a global rating of the encounter by a behavioral science preceptor who observed the encounter, and a summary score derived from a checklist completed by the preceptor. RESULTS: Analyses identified strong correlations between all four of the preceptor and patient ratings, a strong independent effect of case scenario, and significant between-rater variation. When multivariable analysis was used to predict these global ratings based on coding of specific behaviors, a relatively high proportion of observer variation was explained by a small group of coded behaviors. CONCLUSIONS: This study suggests that the coding of specific behaviors may hold promise as a student evaluation technique thereby improving medical training techniques and ultimately enhancing the communication skills in physician-patient encounters. It also illustrates the need to better clarify which specific behaviors are most critical in influencing patient satisfaction.