1. M I C A HGI N DENTISTRY Development and Implementation of a New Course Regarding Patients with Special Health Care Needs Stephanie M Munz, MR Inglehart & RK Niemer University of Michigan SCDA Meeting 2014

2. M I C A HGI N DENTISTRY BACKGROUND Focused Pre-doctoral Education in Special Care Dentistry Is this a new phenomenon?  How many schools teach this in the didactic curriculum?  How many schools have a clinical component?  How many schools have a dedicated clinic space?  How many dental schools have collaborative efforts with other health care professional schools and programs?

3. M I C A HGI N DENTISTRY CODA Standard  Standard 2-24 “Graduates must be competent in assessing the treatment needs of patients with special needs.”

4. M I C A HGI N DENTISTRY Development of a New Course  Introduced as one course of three in a module for third year dental students  Many topics were previously addressed in separation as aspects of other courses.  Includes a subsequent clinical rotation component at the adjacent University of Michigan Health System in the Oral and Maxillofacial Surgery/Hospital Dentistry Clinic  Patients with special health care needs (SHCNs) are often referred to the University of Michigan Hospital Dentistry Clinic for comprehensive care when it is not appropriate in a pre-doctoral clinic environment.

5. M I C A HGI N DENTISTRY Patients with disabilities: Why do we talk about it?  1 st Reason: We all share some common stereotypes that might work against providing the best professional care for persons with disabilities.  most positive: Ulcer, Arthritis, Asthma, Diabetes, Heart disease  most negative: Mental illness, Alcoholism, Mental impairment, Ex-convict, Tuberculosis

6. M I C A HGI N DENTISTRY Why?  2 nd Reason: These patients are likely to have access to dental care issues. If you don’t learn about these issues, you will be less comfortable and less likely to treat patients with SHCNs. Dao, Zwetchkenbaum & Inglehart. General Dentists and Special Needs Patients – Does Dental Education Matter?

7. M I C A HGI N DENTISTRY Education and ….

8. M I C A HGI N DENTISTRY Why?  3 rd Reason: Patients with disabilities are likely to have  More dental disease  More missing teeth  More problems finding dental care.  Prevention is key!!!

9. M I C A HGI N DENTISTRY OBJECTIVES  To assess attendance of classes, use of podcasts and aspects of the new course that are evaluated as helpful at the midterm time of the class.  To assess how well the students evaluate their educational experiences in classroom, clinic and community settings,  which topics are seen as interesting vs. not interesting and how interested the students are in the topics presented, and  which attitudes they hold concerning these issues.

10. M I C A HGI N DENTISTRY METHODS  Respondents: Data were collected from two separate classes of third year dental students.  Midterm data were collected from 40 students in the Winter term and from 55 students in the Spring/Summer term course.  End of term data were collected from 84 students in the Winter Term and from 31 students in the Spring/Summer term course.  Procedure: Data were collected with anonymous web-based surveys at the midterm and end of the two semesters.  Educational intervention:  The class consisted of 14 sessions.  The lectures focused on specific patient groups and their management.  Cases and guest speakers in their respective disciplines and a guest patient speaker were included.

11. M I C A HGI N DENTISTRY MATERIALS  The midterm survey consisted of 2 closed and 4 open ended questions concerning attendance, use of podcasts, and aspects of the course that were useful/ not useful.  The end survey consisted of 20 closed ended questions concerning  interest in the course overall as well as in learning about specific patient groups,  evaluation of how well their education had prepared them to treat patients with SHCNs and medical complexity,  attitudes towards providing care for these patients,  confidence when doing so, and  challenges they perceive.  In addition, 4 open ended questions inquired about aspects of the class that were useful / not useful.

12. M I C A HGI N DENTISTRY Results - Objective 1  Objective 1 was to assess attendance of classes, use of podcasts and aspects of the course that are evaluated as helpful at the time of the midterm.  Only 15% of the students in class 1 and 42% in class 2 attended all lectures until the midterm.  Of those students who did not attend, only 13% in class 1 and 13% in class 2 listened to the podcasts of all classes they missed.  When asked what were helpful aspects of the class  26% indicated attending lectures  23% chose powerpoint slides and cases / examples and  11% named podcasts.

13. M I C A HGI N DENTISTRY Results – Objective 2a Evaluation of educational experiences  Objective 2a was to assess how these students evaluated the quality of their classroom based, clinical and community based education concerning providing care for patients with SHCNs and for medically complex patients at the end of the term.

14. M I C A HGI N DENTISTRY Results – Objective 2a Evaluation of educational experience

15. M I C A HGI N DENTISTRY Results – Objective 2b Interest in topics

16. M I C A HGI N DENTISTRY Results – Objective 2b Interest in topics – Open ended

17. M I C A HGI N DENTISTRY Results – Objective 2c Attitudes

18. M I C A HGI N DENTISTRY LESSONS LEARNED  Overall, results showed students were not very interested in the topics.  Of these, patients with developmental disabilities and head/neck cancer were most interesting.  Patients with medical complexity and mental illnesses were least interesting due to reported repetition of this material.

19. M I C A HGI N DENTISTRY LESSONS LEARNED  Students reported they would appreciate learning about these topics in hands-on clinical settings rather than in a didactic setting.  Nevertheless, they reported high satisfaction when hearing directly from patients about their diagnoses and experiences.

20. M I C A HGI N DENTISTRY Emphasize Practice Enhancing Skills  Gain referrals from physicians  Become a consulting source for your local hospital/urgent care  Treat one special patient, treat their entire family and all their friends and neighbors

21. M I C A HGI N DENTISTRY RECOMMENDATIONS  In the future, case discussion and application should be further incorporated for preparation and competence in the clinical environment.  While a two-week clinical rotation already exists in the pre-doctoral curriculum, improved preparation for and integration of this rotation is recommended and achievable.  The addition of the Delta Dental of Michigan Integrated Special Care Clinic for the treatment of patients with SHCNs will augment this ability to apply didactic knowledge to the treatment of patients.

22. M I C A HGI N DENTISTRY CONCLUSIONS 1. Lack of student interest in the topics of patients with SHCNs and medical complexity is likely due to “lecture fatigue” as well as repetition of some material in the curriculum. 2. Active learning models, including case discussion and application should be incorporated for increased engagement. This can be used to emphasize the importance of this aspect of dentistry as well as increase students’ levels of competence and confidence. 3. Collaboration with other health care professionals in a subsequent, sustained clinical experience will also increase clinical competence and confidence, making it more likely that graduates will pursue treatment opportunities for patients with SHCNs.

23. M I C A HGI N DENTISTRY REFERENCES 1. Chavez EM, Subar PE, Miles J, Wong A, Labarre EE, Glassman P. Perceptions of predoctoral dental education and practice patterns in special care dentistry. J Dent Educ. 2011 Jun;75(6):726-32. 2. Dao LP, Zwetchkenbaum S, Inglehart MR. General dentists and special needs patients: does dental education matter? J Dent Educ. 2005 Oct;69(10):1107- 15. 3. Greig V, Sweeney P. Special care dentistry for general dental practice. Dent Update. 2013 Jul-Aug;40(6):452-4, 456-8, 460. 4. Krause M, Vainio L, Zwetchkenbaum S, Inglehart MR. Dental education about patients with special needs: a survey of U.S. and Canadian dental schools. J Dent Educ. 2010 Nov;74(11):1179-89. 5. Subar PE, Chavez EM, Miles J, Wong A, Glassman P, Labarre EE. Pre- and postdoctoral dental education compared to practice patterns in special care dentistry. J Dent Educ. 2012 Dec;76(12):1623-8.

24. M I C A HGI N DENTISTRY ACKNOWLEDGEMENTS * This research was initiated as an evaluation of a newly designed pre- doctoral didactic course aimed at comprehensive clinical management of the adult patient with special health care needs and medical complexity at the University of Michigan – School of Dentistry and in conjunction with the third author’s affiliation with the University of Michigan Center for Research on Learning and Teaching.

25. M I C A HGI N DENTISTRY Questions or comments are welcome: smmunz@med.umich.edu