|
|
||||||||
Critical Issues in Dental Education |
Key words: accreditation, special needs patients, developmental disabilities
Submitted for publication 08/30/04; accepted 10/25/04
Abstract |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
Accreditation standards relevant to the teaching of the care of individuals with special needs have undergone a number of changes during the past decade. Until the mid-1990s, standards required a "clinical experience designed to complement didactic instruction in the dental management of the handicapped or medically compromised patients."2 In line with the competency-based review process, schools next were challenged to ensure that, "at minimum, graduates are competent in providing care within the scope of general dentistry, as defined by the school, for child, adolescent, adult, geriatric, and medically compromised patients."3 The recent modification in standards for dental education programs seeks to recognize and specifically prepare the next generations of practitioners who will be called upon to care for individuals who live in our communities and whose physical and intellectual limitations extend beyond the traditional definition of a "medically compromised patient."4
Numbers |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
Approximately 2 percent of school-age children have a serious developmental disability such as mental retardation or cerebral palsy and need special education services or supportive care.7
Results from the 2000 census indicated that:
Deinstitutionalization |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
In the past, large state facilities, to some degree, offered a wide range of in-house health services provided by medical and dental staff employees. Almost all of the current community residential facilities, however, are too small to provide in-house intramural services beyond the annual examination required in some states.9 As a consequence, the residents in community facilities are dependent upon local practitioners for health services.
Dental Student Education |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
As a result, one should not be surprised that only 10 percent of general dentists responding in one study said that they treat children with cerebral palsy, mental retardation, or medically compromising conditions often or very often. Seventy percent reported that they rarely or never treated children with cerebral palsy in their practice.15
In addition, a national study of dental hygiene programs reported comparable findings: 48 percent of 170 programs had ten hours or less of didactic training (including 14 percent with five hours or less); and 57 percent of programs reported no clinical experience.16
Bringing About Change |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
The following series of events and activities led to the establishment of the current CODA standard related to the care of patients with special needs:
Realities |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
The first of these difficulties involves economics. In an effort to meet operating costs of dental schools, the price for a four-year dental education at some private schools has reached the range of a quarter of a million dollars. In the past year, dental school financial difficulties were exacerbated by the federal governments elimination of Graduate Medical Education funds for dental school-sponsored general practice and specialty education programs. In 2002, student education debt for almost three out of five dental school graduates was in excess of $100,000.19
Another significant area of difficulty involves faculty. Unfilled faculty positions continue as practitioners are unwilling to leave lucrative practices for teaching appointments with limited compensation, which in turn results from the precarious financial state of schools of dentistry. Recent graduates are reluctant to pursue a full-time academic career because of their outstanding debt load and inadequate level of remuneration.
In addition, there is the added reality that there may be limited numbers of trained and prepared practitioners to provide the didactic and clinical programmatic support for the development of education experiences for patients with special needs for predoctoral students. Nevertheless, there are programs that offer models for schools to follow as they develop educational opportunities for their students.
Translating Accreditation Standards into Programs |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
The didactic part of the predoctoral program begins in year two as an integrated component of the Childrens Dentistry curriculum. The course includes a seven-hour series that addresses the issues involved in assessing and treating individuals with varied disabilities. A step-by-step approach begins with risk management, followed by treatment planning and the delivery of care. Topics include how to identify risk of disease, along with the appropriate scope of care, informed consent, management of behavioral issues, and conventional vs. alternative treatment modalities. Lectures include case-based learning techniques and standard lecture formats. Patients with management challenges, including children with special needs, who require limited oral care are treated during this second-year period. Medical, developmental, and social topics specific to care of patients with special needs are presented in year three. As the students progress during the third year, they provide care to patients with increasingly complex treatment needs and management challenges. In their senior year, all students participate in a thirteen-week comprehensive care clinic that is specific to adults with special needs.
The postgraduate program includes a twelvemonth fellowship and rotations for general practice residents from the University and Northport Veterans Hospitals and the New York University Hospital of Queens. Patient care is provided in clinic and operating room settings. The didactic component includes seminars and case presentations for case-based learning. The program encourages and supports fellows, graduate students, and predoctoral students to develop or participate in research projects.
In line with our management philosophy, SUNY-Stony Brook School of Dental Medicine promotes the concept that a responsibility of the dental professional is to educate and train caregivers to be competent and effective oral health providers. We promote behavior modification coupled with physical immobilization as needed for the individual. Oral sedation, if necessary, may be available for patients who are not amenable to any other form of treatment due to behavioral or medical concerns.
The predoctoral and postdoctoral programs generate approximately 2,000 outpatient visits annually for over 800 patients. A survey of school and program graduates revealed that the majority (68 percent) of former students are providing care for patients with special needs in their practices or supervised care in educational settings.23 The frequently reported research finding that contact with individuals with special health care needs eases and encourages a working relationship between provider and patients is borne out in our experience.14
West Virginia University School of Dentistry |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
Students received in-depth didactic instruction on the following ten special health care needs topics: intellectual disabilities, cerebral palsy, muscular dystrophy, epilepsy, attention deficit disorder, autism, visual and other communicative disorders, congenital and rheumatic heart disease, hemorrhagic disorders and blood dyscrasias, and respiratory diseases. Students also received instruction on the prevalence of dental disease in youngsters and adults with intellectual and other developmental disabilities (IDD) and the delivery of dental care for patients with IDD, including diagnostic evaluation and treatment planning, preventive dental therapies, comprehensive treatment modalities, and behavior management techniques.
The didactic course was complemented with a one-year clinical course. The course consisted of clinical training in providing comprehensive dental care for persons with IDD in the WVU Pediatric Dentistry Clinic or authorized remote sites, including Spencer State Hospital, Weston State Hospital, or Potomac Center. On average, each student was scheduled for one two-hour, biweekly clinic session of patient care in the Pediatric Dentistry Clinic or the equivalent in authorized remote sites for two semesters (thirty clock-hours) during which the treatment of two to four patients was completed. Students were evaluated on their ability to obtain medical and dental histories, perform clinical examinations, summarize the child and adult patients condition and need for care, recommend the most favorable course of services, and perform the actual delivery of care.
Students also were assigned to participate in various WVU Hospital medical clinics, including special genetics, hematology, oncology, neurology, and cardiology. In addition, students participated in the Cleft Lip and Palate Clinic program. Participation in the WVU Hospital medical clinic rotations exposed students to forty to fifty patients with a variety of special health care needs. Students provided an oral health assessment on each of these patients during interdisciplinary staff meetings. This process maximized each students clinical training in both diagnosing oral diseases and conditions associated with specific medical conditions and behavior management techniques without increasing the students individual patient portfolio or significantly overburdening the schools clinical curriculum.
Other Programs |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
Furthermore, in early 2004, the American Academy of Developmental Medicine and Dentistry (AADMD) in partnership with Special Olympics initiated the Curriculum Assessment of Needs (CAN) Project in response to both anecdotal information and evidence-based data which suggested that U.S. medical and dental students are not being prepared adequately to provide comprehensive health care services for persons with intellectual and/or other developmental disabilities.25 Survey data released by Special Olympics University, an international teaching, sharing, and managing program to support individuals with intellectual disabilities, indicated that 75 percent of dental health students and professionals reported never having treated a person with intellectual disabilities and only 45.9 percent reported that they were very comfortable around individuals with mental retardation.26 Clearly, any long-term success in reducing the current disappointing access to care for persons with special needs will require a significant improvement in the educational programs in our dental schools.
The CAN Project initially will consist of a series of national surveys targeting the deans of all U.S. colleges of medicine and dentistry, as well as the directors of programs in the various medical and dental general and specialty practices. A second target audience will be the major medical and dental professional organizations and the University Centers for Excellence in Developmental Disabilities Education, Research, and Service (UCEDD). The deans survey will assess the attitudes of medical and dental school deans regarding the value of required training focused on providing care for patients with developmental disabilities. The program directors survey will probe for the presence and strength of postdoctoral specialty training for patients with special needs. Finally, the organizational/UCEDD survey will identify those major medical and dental professional organizations with significant curriculum focused on this population.
The CAN Project was developed to identify those faculty most knowledgeable in providing comprehensive health care services in conjunction with training future health care practitioners in the area of special needs at their respective institutions. The CAN investigators will utilize the information gained to formulate a multilevel, in-depth didactic and clinical curriculum that can be used by colleges of medicine and dentistry and postgraduate residency programs to adequately train their students to provide the necessary medical and dental services so often denied to persons with intellectual and/or other developmental disabilities.
The Search for Solutions |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
Thus, as dental school educators have recognized the need to prepare their students for the care of our swelling geriatric population with its accompanying panorama of medical complications, so too must we develop innovative approaches to prepare our graduates for the care of special populations.
In this process, we must broaden our perception of special populations to include individuals with intellectual and development disabilities who reside in our communities and/or remain institutionalized, as well as the homeless, the homebound, and nursing home patients who also face barriers in receiving care. We must meet the challenge of the Commission on Dental Accreditation to ensure that graduates will indeed "be competent in assessing the treatment needs of patients with special needs."
Footnotes |
---|
REFERENCES |
---|
Top Abstract Numbers Deinstitutionalization Dental student education Bringing about change Realities Translating accreditation... West virginia university school... Other programs The search for solutions References |
---|
This article has been cited by other articles:
|
L. Vainio, M. Krause, and M. R. Inglehart Patients with Special Needs: Dental Students' Educational Experiences, Attitudes, and Behavior J Dent Educ., January 1, 2011; 75(1): 13 - 22. [Abstract] [Full Text] [PDF] |
||||
|
M. Krause, L. Vainio, S. Zwetchkenbaum, and M. R. Inglehart Dental Education About Patients with Special Needs: A Survey of U.S. and Canadian Dental Schools J Dent Educ., November 1, 2010; 74(11): 1179 - 1189. [Abstract] [Full Text] [PDF] |
||||
|
P. A. Moore, S. G. Boynes, M. A. Cuddy, J. A. Giovannitti Jr., and J. Zovko Educational Experiences and Preparedness in Dental Anesthesia: Five-Year Outcome Assessment and Conclusions J Dent Educ., December 1, 2009; 73(12): 1379 - 1386. [Abstract] [Full Text] [PDF] |
||||
|
L. M. DeLucia and E. L. Davis Dental Students' Attitudes Toward the Care of Individuals with Intellectual Disabilities: Relationship Between Instruction and Experience J Dent Educ., April 1, 2009; 73(4): 445 - 453. [Abstract] [Full Text] [PDF] |
||||
|
D. M. Schwenk, D. C. Stoeckel, and S. E. Rieken Survey of Special Patient Care Programs at U.S. and Canadian Dental Schools J Dent Educ., September 1, 2007; 71(9): 1153 - 1159. [Abstract] [Full Text] [PDF] |
||||
|
N. T. Keselyak, M. Simmer-Beck, K. K. Bray, and C. C. Gadbury-Amyot Evaluation of an Academic Service-Learning Course on Special Needs Patients for Dental Hygiene Students: A Qualitative Study J Dent Educ., March 1, 2007; 71(3): 378 - 392. [Abstract] [Full Text] [PDF] |
||||
|
H. L. Kleinert, C. Sanders, J. Mink, D. Nash, J. Johnson, S. Boyd, and S. Challman Improving Student Dentist Competencies and Perception of Difficulty in Delivering Care to Children with Developmental Disabilities Using a Virtual Patient Module J Dent Educ., February 1, 2007; 71(2): 279 - 286. [Abstract] [Full Text] [PDF] |
||||
|
H. B. Waldman and S. P. Perlman A special care dentistry specialty: sounds good, but . . . J Dent Educ., October 1, 2006; 70(10): 1019 - 1022. [Full Text] [PDF] |
||||
|
R. A. Kuthy, M. R. McQuistan, K. J. Riniker, K. E. Heller, and F. Qian Students' Comfort Level in Treating Vulnerable Populations and Future Willingness to Treat: Results Prior to Extramural Participation J Dent Educ., December 1, 2005; 69(12): 1307 - 1314. [Abstract] [Full Text] [PDF] |
||||
|
L. P. Dao, S. Zwetchkenbaum, and M. R. Inglehart General Dentists and Special Needs Patients: Does Dental Education Matter? J Dent Educ., October 1, 2005; 69(10): 1107 - 1115. [Abstract] [Full Text] [PDF] |
||||
|
HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |