Care Training: National Survey and Interview Results Evaluating - PowerPoint PPT Presentation

Assessment of Oral Health Education in Primary Care Training: National Survey and Interview Results Evaluating Multidisciplinary Education Judith A. Savageau, MPH Kate Sullivan, BA Hugh Silk, MD, MPH Gail Sawosik, MBA University of Massachusetts Medical School Department of Family Medicine and Community Health American Public Health Association Annual Meeting; November, 2018

Disclosure • I, and all project team members, have no relationships to disclose.

Objectives • Describe the current landscape of oral health teaching in primary care disciplines’ training programs • Identify the specific elements that influence curriculum development • Identify the barriers and factors related to a program director’s satisfaction with oral health competence among their learners

Christine Riedy, PhD, MPH (Lead PI); Russ Phillips, MD; Hugh Silk, MD, MPH (Co-PIs) HRSA Cooperative Agreement: UH1HP29962

CIPCOH serves as a national resource for systems-level research on oral health integration into primary care training with special emphasis on training enhancements that will train primary care providers to deliver high quality, cost-effective, patient- centered care that promotes oral health, addresses oral health disparities, and meets the unique needs of all communities. CIPCOH’s Objectives: • Conduct Systems-Level Research on Primary Care Training • Disseminate Current Research, Evidence-Based or Best Practices, and Evaluation Tools • Develop a Community of Practice

UMMS CIPCOH Projects to Date Year 1 Project • Evaluate the integration of oral health into primary care curricula using a national survey of 13 primary care disciplines Year 2 Project • Qualitatively evaluate the impact of oral health integration on training outcomes among non-dental program/school champions Year 3 Project • Convene a Delphi group to create an evaluation tool to assess the oral health curriculum in health schools and primary care residencies

Year 1 - Methodology • 13 nationwide surveys were distributed electronically across multiple disciplines • Univariate statistics/frequencies were used to describe all survey items • Sub-analyses assessed influences of OH in the curriculum such as having a faculty oral health champion, program demographics, formal dental faculty teaching, etc. • Analyses were conducted with programs that had at least a 40% response rate (10 of 13 programs)

For most disciplines, less than 1 in 4 program directors were satisfied with the OH competence of their trainees at the time of graduation.

OH Analysis of Relationships within Programs of Having an OH Champion and: Satisfaction with OH Competence of Graduates, # of Hours of OH in Curriculum, and Existence of Relationship between Program and Dental School, Residency or Hygiene Program

Total Quality Score for Each Discipline Peds/ Physician Adult DO Schools Fam Med Geriatrics Midwifery Pedi NP Med-Peds Assistant Geri NP FNP (N=106) MAXIMUM # (N=22) (N=195) (N=75) (N=33) (N=50) (N=110) (N=102) (N=74) (41%) OF POSSIBLE (52%) (40%) (51%) (85%) (68%) (40%) (42%) (56%) POINTS INPUTS Champion/etc. 6 10 1 4 7 2 2 9 1 10 Department support INPUTS 1 0 0 0 1 0 1 1 1 1 Documents PROCESS 2 3 3 2 3 2 2 3 2 3 Hours/Day PROCESS Topics: 2 2 0 0 4 4 2 4 4 4 Risk Assessment Oral Health Education Topics: Prevention/intervention Communication 4 6 2 1 7 3 2 7 7 7 Interprofessional Collab Other SFL 0 0 0 0 1 1 0 1 0 1 OUTPUTS 2 1 0 0 2 2 1 2 1 2 Evaluation Perceived Competence 3 3 0 0 6 0 0 6 0 6 TOTAL SCORE 20 25 6 7 31 14 10 33 16 34

Year 1 – Lessons Learned • Champions are important for # of hours, satisfaction with OH competence of trainees, and creating relationships • Time and lack of faculty expertise are major barriers • Physician Assistants and Nurse Practitioners are leading the way; Family Medicine and Geriatrics need more effort/support

Year 2 - Methodology • Development of a structured interview guide • 31 primary care training programs that had self-identified as “best practice” OH programs participated in a 1 -hour interview (all 13 disciplines interviewed) • Qualitative analysis of the 31 interview transcripts, development of a coding schema • 7 major themes and sub-themes were identified

Year 2 – Demographics N (%) N (%) In what region of the country is your program located? It is important for primary care providers to address Northeast 9 (29) their patients’ basic oral healthcare issues (e.g., Midwest 7 (23) caries prevention, dental referrals). South 9 (29) Strongly Agree 27 (87) West 6 (19) Agree 2 (6) Neutral 0 (0) For how many years has your program been training Disagree 0 (0) learners? Strongly Disagree 2 (6) 1-5 4 (13) I am satisfied with the current level of competence 6-10 1 (3) 11-15 3 (10) that our graduates achieve in oral health. 16+ 23 (74) Strongly Agree 6 (19) What is the approximate number of learners enrolled in Agree 4 (13) your program per year? (N=29) Neutral 13 (42) 1-10 7 (24) Disagree 8 (26) 11-20 7 (24) Strongly Disagree 0 (0) 21-30 4 (14) Mean (SD) >30 11 (38) Number of Years OH in Curriculum (interview data) How many hours of oral health are in your curriculum? Range 1.5 years to 50 years 8.2 (9.5) 1-3 6 (19) 4-6 7 (23) Range 1.5 years to 21 years (excluding outlier of 50 6.7 (5.4) years) 7-9 4 (13) 10+ 14 (45)

Major Themes Sub-Themes 1. Driving Force / Impetus / Motivation a. Experience: personal, practice or community-based b. Passion/interest c. New/Existing funding d. New/Existing relationship with dental partners e. Social justice/lack of access/population considerations f. Important topic 2. Topics / Competencies / Objectives Rationale a. External Influences: borrowed from existing curriculum, heard at a conference, read in the literature b. Internal Influences: local faculty expertise, local dental partners c. Patient population / geographic considerations / epidemiologic data d. Academic Requirements: board exam prep, accreditation / certification requirements, tied to competencies / objectives and/or EPAs e. Tied to funding / insurance reimbursements (fluoride) 3. Best Aspect / Curriculum Structure a. Knowledge-based didactics b. Skills-based experiences (e.g., OH exam, counseling, varnish) c. Clinical experiences / rotations / OH electives d. Integration of OH into existing curriculum e. Partnering with other faculty, IPE partnerships, dental collaborations 4. Barriers / Challenges a. Lack of time / curriculum restraints b. Lack of buy in (faculty, department, institution level) c. Lack of faculty knowledge / expertise / interest d. Lack of access to care for patients e. Lack of dental (and non-dental) partner(s) / relationship(s) f. Lack of champion (problems with champion sustainability) g. Lack of funding availability / Loss of funding h. Lack of medical / dental integration

Major Themes Sub-Themes 5. Dental Relationships / IPE a. Collaboration with dental school or residency or hygiene program b. Non-dental expert OH teaching c. Faculty appointments d. Dental resources (e.g., handouts, supplies, referral lists) 6. Evaluation Strategies / Styles a. Quiz / Test questions (e.g., SFL) b. Clinical observation/assessment/feedback c. Attitudinal-based (e.g., toward other professions) d. OSCE / Simulation experiences 7. Lessons Learned / Advice / Recommendations a. Borrow (i.e., don’t reinvent the wheel) b. Pilot curriculum c. Obtain / Sustain a champion d. Obtain buy-in (faculty, department, institution level) e. Obtain / Sustain funding f. Devote time / make time in the curriculum g. Relationships: establish / reinforce relationship with dental partners and non-dental OH experts h. Include / Improve evaluation component(s) i. Make OH part of what you already do/teach j. Include / Improve IPE component k. Include / Improve OH Elective l. Pt education (e.g., insurance, referral lists, resources, etc.)

Year 2 – Quotes • Motivation for teaching oral health: “As a nurse practitioner, I worked on the border of (state deleted) and (state deleted). One of the things that I saw, that was a desperate need, and where I knew I wasn’t trained, was oral health. Everybody came to me because they had no access to dental care.” – Family Nurse Practitioner • On borrowing material for others: “There is no sense in reinventing the wheel when the wheel is like a Cadillac.” (referring to the SFL curriculum) – PA Assistant Program Director • Integrating oral health into existing curricula: “Incorporating that knowledge of oral health into the regular physical exam I think has enhanced our ability to really pick up some potential problems that may turn into medical problems later on.” – Osteopathic Medical School Dean

Year 2 - Lessons Learned • Oral health champions are vital for starting and sustaining curricula • Make OH education a part of the overall curriculum (and not an ‘add - on’) • Maximize local resources by working with local dental professionals and organizations • Learners do well with skill-based sessions, whether that means a procedure workshop or actual clinical experiences