Dental Students’ Reflections on Clinical Placement in a Rural and Indigenous Community in Australia

Community-based education programmes in the context of dental education: A scoping review

BACKGROUND

Community education programmes are vital tools for teaching skills, such as understanding the larger cultural, economic and social determinants of health and how these factors impact people's health. It is currently unclear whether community education programmes in the field of dentistry deliver adequate value. This review aims to scope, collate and analyse globally published evidence concerning community education programmes in dentistry from inception, to gain an understanding of the intentions for these programmes and establish whether outcomes have shifted over time from the original intentions.

METHODS

Arksey and O'Malley's framework for scoping reviews was employed to guide the reviewers. A systematic search of electronic databases and the reference lists in key papers was conducted.

RESULTS

A systematic search concerning community education in dentistry identified a total of 140 papers for full-text evaluations. After further exclusions, 115 articles were selected for data charting. There was a lack of clarity in the literature concerning programmes' definitions and strategies for achieving intentions. Origins, intentions and motivations of the programmes were identified. The literature largely focused on assessing students' clinical treatment skills, contradicting the programme's original idea and intentions. Only a few studies incorporated patient and community perspectives, and the majority of assessments were self-reported, primarily by students.

CONCLUSIONS

There is broad interest in integrating community education into dental curricula to teach complex concepts, dental public health principles and to ensure professional skills development. We identified issues in the literature around programme definitions, strategies, measurement approaches and programme success requiring additional research.

Learning on the country: Motivating dental students to attend a rural placement

PURPOSE/OBJECTIVES

This research aimed to identify factors that affect dental students' attitudes toward participation in rural clinical outplacements (RCOP) in Australia, and to suggest strategies that will increase students' desire to attend RCOP in the future.

METHODS

Dental students from the nine dental schools in Australia were invited to an online survey on their willingness to participate in an RCOP and the factors that influence this willingness. These factors were grouped into themes of education, personal and health, social, financial, and information-related.

RESULTS

The study had an estimated response rate of 10% with 202 responses. More than two-thirds (68%) of students were willing to participate in an RCOP. Students who grew up in a rural area were significantly more likely to be willing to attend an RCOP, compared to those from urban settings. Attitudes toward the anticipated educational experience of RCOP were positive, while factors related to finances and pre-existing information were of concern to students. Educational, personal/health-related, and social factors had significant impacts on participants' willingness to attend RCOP.

CONCLUSION

Overall, despite students holding negative opinions on certain social and financial factors, their positive attitudes toward other factors outweighed these. Universities should aim to further promote the educational benefits of RCOP to improve students' attitudes prior to attending RCOP. In-depth qualitative analysis is required to explore students' concerns regarding RCOP and longitudinal research is warranted to monitor students' attitudes toward RCOP and rural work over time.

The Kimberley Dental Team: A process evaluation of a volunteer dental programme serving remote Aboriginal communities in Australia

OBJECTIVES

This study aims to conduct a process evaluation of the Kimberley Dental Team (KDT), a not-for-profit, volunteer organization providing care to remote Aboriginal communities in Western Australia.

METHODS

A logic model was constructed to detail the operational context of the KDT model. Subsequently, the fidelity (the extent to which each of the programme's elements were implemented as planned), dose (types and quantity of services provided) and reach (demographic characteristics and communities serviced) of the KDT model were evaluated using service data, deidentified clinical records and volunteer rosters maintained by KDT from 2009 to 2019. Trends and patterns of service provision were analysed using total counts and proportions over time. A Poisson regression model was used to explore changed in the rates of surgical treatment over time. The associations between volunteer activity and service provision was also investigated using correlation coefficients and linear regression.

RESULTS

A total of 6365 patients (98% identifying as Aboriginal or Torres Strait Islander) were seen over the 10-year period with services being provided across 35 different communities in the Kimberley. Most services were provided to school-aged children, consistent with the programme's objectives. The peak preventive, restorative and surgical rates occurred among school-aged children, young adults and older adults respectively. A trend was observed indicating a reducing rate of surgical procedures from 2010 to 2019 (p < .001). The volunteer profile showed significant diversity beyond the conventional dentist-nurse structure and 40% being repeat volunteers.

CONCLUSIONS

The KDT programme maintained a strong focus on service provision to school-aged children over the last decade with the educational and preventive components being central to the care being provided. This process evaluation found that the dose and reach of the KDT model grew with an increase in resources and was adaptive to perceived community need. The model was shown to evolve through gradual structural adaptations contributing to its overall fidelity.

'The dental nurse played a vital role in helping to manage the patient': a thematic analysis of undergraduate dental students' reflective journals from outreach placements

Introduction Community-based dental education, or 'outreach', forms a key part of dental courses in some high-income countries. Its educational benefits are well-established and once graduated, participants feel better prepared for their early career. Yet, it is less clear what students actually learn while on placements.Materials and method Qualitative document and thematic analysis of a convenience sample of anonymised dental student reflective journals (n = 51).Results The reflective journals described varied and broadly positive learning experiences. Analysis identified a number of themes of learning. Most related to the process and outcomes of care, but two key themes - dental anxiety and teamworking - were interrelated with both. Within teamworking, dental nurses appeared important in students' learning. Three process interrelated themes of learning were identified in the data. These were: tailoring your approach; communication and time; and evidence-based dentistry and minimising risk. Two broad interrelated themes relating to outcomes for patients and students were also identified: trust and confidence; and professionalism and personal development.Conclusion This research identified important and potentially transformative learning from outreach placements. This included how dental anxiety impacts patients and the dental team, the importance of teamworking, and the role of dental nurses in students' experiential learning.

Short-term international dental experiences in undergraduate dental students at an Australian university

INTRODUCTION

Learning through international experience has been well documented in USA literature, yet not well explored in Australia. The aim of this study is to understand Australian dental students' experiences and perceptions of international dental experience by: (i) capturing past participation; (ii) identifying potential interests for participants who have not been on a trip and (iii) ascertaining perceived benefits of the trip/s.

MATERIALS AND METHODS

A 19 question paper survey was distributed to 310 eligible undergraduate dental students of The University of Queensland (UQ). An online counterpart survey was created via Google Forms and promoted on relevant Facebook groups targeted at current dental students of UQ.

RESULTS

A total of 203 of the 310 eligible UQ undergraduate dental students responded to the distributed paper and electronic surveys making the response rate 65.5%. A total of 13 undergraduate respondents participated in an international experience trip. The majority of respondents who had not participated in an international dental experience trip were interested in participating in one. Education (84.6%) and improved dental skills (84.6%) were the most reported perceived benefits by the students who had participated in an international dental experience.

CONCLUSION

A majority of respondents were interested in participating in international dental experiences. Despite this, only 1 in 15 respondents had participated in an international dental experience. Further exploration of this concept is needed; however, dental schools within Australia could potentially explore integration of international short-term dental experiences into formal curricula in the future.

Perceptions of orthopaedic medicine students and their supervisors about practice-based learning: an exploratory qualitative study

BACKGROUND

Practice-based learning is crucial in forming appropriate strategies for improving learning among the medical students that support the country's understaffed health sector. Unsatisfactory learning consequently results in poor performance of students and poor quality of health care workforce in the long run. Exploring the perceptions about the current practice-based learning system and how to improve is thus vital. This study set out to explore the perceptions of Orthopaedic medicine students and their supervisors about practice-based learning at a tertiary training hospital.

METHODS

This was an exploratory phenomenological qualitative study that involved in-depth interviews among 10 Orthopedic students during their rotation in the emergency ward of Mulago hospital and 6 of their supervisors. Interviews were audio-recorded, transcribed, and then imported into Atlas ti 8.3 for analysis. The data were coded and grouped into themes relating to perceptions of practice-based learning, general inductive analysis was used. The general inductive approach involved condensing the raw textual data into a brief and summary format. The summarized format was then analyzed to establish clear links between the perceptions of practice-based learning and the summary findings derived from the raw data.

RESULTS

The mean age of the students was 23 ± 1.5 years. Four out of the six supervisors were Orthopaedic officers while the remaining two were principal Orthopaedic officers, four out of the six had a university degree while the other two were diploma holders. The main themes arising were hands-on skills, an unconducive learning environment, the best form of learning, and having an undefined training structure. Particularly, the perceptions included the presence of too many students on the wards during the rotation, frequent stock-outs of supplies for learning, and supervisors being overwhelmed caring for a large number of patients.

CONCLUSION

Barriers to satisfactory practice-based learning were overcrowding on the wards and insufficient training materials. To improve practice-based learning, adequate learning materials are required and the number of students enrolled needs to be appropriate for the student - supervisor ratio.

Five ways to get a grip on the need to include clinical placements in Indigenous settings

Educational organizations that train medical professionals are intricately linked to the responsibility of creating culturally safe healthcare providers. However, prevailing inequities contribute to the continued oppression of Indigenous peoples, evidenced by inequitable access, treatment, and outcomes in the healthcare system. Despite an increasing awareness of how colonialist systems and the structures within them can contribute to health disparities, this awareness has not led to drastic improvements of health outcomes for Indigenous peoples. Many recently graduated health professionals will have likely encountered Indigenous peoples as a minority population within the larger, non-Indigenous context. Clinical placements in Indigenous settings may improve recruitment and retention of healthcare professionals in rural and remote settings, while helping educational institutions fulfill their social accountability missions. These placements may aid in the decolonization of care through reductions in bias and racism of medical professionals. Clinical placements in Indigenous settings may better prepare providers to navigate the dynamic challenges of the healthcare needs of Indigenous peoples safely and respectfully.

Identifying features of quality in rural placements for health students: scoping review

OBJECTIVES

To explore and synthesise the evidence relating to features of quality in rural health student placements.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, CINAHL, Embase, ProQuest, Informit, Scopus, ERIC and several grey literature data sources (1 January 2005 to 13 October 2020).

STUDY SELECTION

The review included peer-reviewed and grey literature from Organisation for Economic Co-operation and Development listed countries that focused on quality of health student placements in regional, rural and remote areas.

DATA EXTRACTION

Data were extracted regarding the methodological and design characteristics of each data source, and the features suggested to contribute to student placement quality under five categories based on a work-integrated learning framework.

RESULTS

Of 2866 resulting papers, 101 were included for data charting and content analysis. The literature was dominated by medicine and nursing student placement research. No literature explicitly defined quality in rural health student placements, although proxy indicators for quality such as satisfaction, positive experiences, overall effectiveness and perceived value were identified. Content analysis resulted in four overarching domains pertaining to features of rural health student placement quality: (1) learning and teaching in a rural context, (2) rural student placement characteristics, (3) key relationships and (4) required infrastructure.

CONCLUSION

The findings suggest that quality in rural health student placements hinges on contextually specific features. Further research is required to explore these findings and ways in which these features can be measured during rural health student placements.

What do dental students value about their rural placements-Is clinical experience enough?

OBJECTIVES

Melbourne Dental School's (MDS) rural dental clinical placement program operates in two Victorian rural areas and offers final year dental students an integrated program of practical clinical experience and rural lifestyle exposure. The objective of this study was to understand the student's experiences to determine whether they increased the likelihood of them seeking rural employment after graduation.

DESIGN

The University of Melbourne final year dental students attended 5-week mandatory rural clinical placements in 2018 and 2019. At the completion of their placement, students were invited to complete an anonymous questionnaire about their experiences, which had both quantitative and qualitative questions. This study examined the qualitative data using thematic analysis to identify common themes.

SETTING

Rural clinical dental placements at Goulburn Valley Health and Latrobe Community Health Service.

PARTICIPANTS

Final year Dentistry and Oral Health students.

INTERVENTIONS

Clinical placementevaluation questionnaire.

MAIN OUTCOME MEASURES

To examinedentalstudents interest in rural practicepost rural clinical placement.

RESULTS

Of the 129 students who completed the survey, 116 completed the open-ended questions and four themes were identified. Rich clinical experience; social capital; rural life and infrastructure. High levels of satisfaction were reported across all themes.

CONCLUSION

This study demonstrated the rural clinical program to be a positive and enjoyable placement which increased dental students' clinical practice experience and their interest in considering rural practice upon graduation. Exposure to rural lifestyle and supportive clinical and social relationships were shown to be important influences. The current survey can benefit from refinement and further research following up MDS graduate workplace locations is recommended.

Clinical supervisors' reflections on their role, training needs and overall experience as dental educators

OBJECTIVES

The aims of this study were to understand the views of clinical supervisors overseeing final year dental students and investigate their perceived role, level of support and training available, and ways to improve the supervisory experience.

METHODS

Clinical supervisors who oversaw fifth-year dental students in 2019 were invited to participate in an online survey. Respondents who indicated their willingness to participate were contacted for a semi-structured interview which were analysed using Constant Comparative Methodology.

RESULTS

Sixteen supervisors completed the survey, with a response rate of 73%. Respondents reported low levels of formal training in clinical supervision (38%) and most (75%) felt further training would be beneficial for their role. While nearly all (94%) reported they had developed as a dental professional through supervision, most (63%) were not positively encouraged to develop a career as a supervisor, with tensions between health service delivery and academia identified as a key challenge. The driving motivator to supervise was a desire to teach (62.5%). Seven (44%) participants completed the semi-structured interview. Participants' perception of their role varied depending on career stage and clinic location. Lack of recognition and defined career pathways were the biggest challenges reported by participants.

CONCLUSION

Retention and morale of supervisors may increase with better-defined career pathways and meaningful professional development opportunities. There is a need to develop tailored training programs for supervisors that enable them to teach critical thinking and clinical judgement while ensuring patient safety.

Five years on: Influences on early career health professionals from a rural interprofessional pre-registration immersion program

OBJECTIVE

To ascertain former students' perceptions of and influences from a final-year pre-registration, rurally located, clinically based, 5 week interprofessional program on their subsequent work and career in the health professions.

DESIGN

Online survey delivered 5 years post-program (4 years post-graduation).

SETTING

The Tairāwhiti interprofessional education program was first undertaken in 2012/2013 by students from six health professional degree programs (dentistry, dietetics, medicine, nursing, pharmacy and physiotherapy) in the Tairāwhiti region, New Zealand.

PARTICIPANTS

Health professionals who attended the Tairāwhiti interprofessional education program in 2012/2013 as students were invited to participate; 70 of 86 (81%) responded in 2017/2018.

RESULTS

Five years on, most respondents (91%;64/70) were working as health professionals, with a fifth (23%;15/64) working overseas. Of those currently practising in New Zealand, 51% (24/47) were working in hospital practice and 49% (23/47) in the community, with 56% (27/48) working in metropolitan areas and 44% (21/48) in regional/rural locations. Of the 51 respondents who provided free-text comments about perceived influences of program participation, the majority described positive influences on their clinical practice as health professionals or their subsequent career choices. Five themes emerged from the free-text data: 'made me a better clinician'; 'made me consider rural/regional work'; 'collaborating for care'; 'choosing an area of practice to work in,' and 'little or no impact.'

CONCLUSION

This work reports positive influences on subsequent careers among respondents who had previously participated as final-year students in a rurally located IPE program, particularly with respect to interprofessional working, rural health, and contextual and cultural influences.

Pre-Outplacement Perceptions of Dental Students Regarding Rural Oral Health Practice and Associated Factors

Rural outplacement programs have been offered by Australian universities to encourage dental students to consider rural careers. The dental curricula should be designed to provide graduates with a good understanding of oral health issues that rural oral health care workers face. Pre-outplacement perceptions of dental students on rural practice are considered imperative to review and update the outplacement programs; however, they have not been investigated in detail. An online, anonymous, voluntary survey was conducted among the first-year dental students. The responses were solicited on the level of awareness and understanding of rural oral health, intention to practice in rural locations and factors informing the appeal of rural dental practice. The mean of a seven-point Likert scale revealed that most students had some level of perceived knowledge and awareness of rural communities and oral health. Students with rural affiliation were more likely to have the intent to practise rurally after graduation (p = 0.001). For short-term rural practice, students overall expressed positive intention. Greater job opportunities were the main motivating factor, while the distance from family and friends was the main deterring factor for practising rurally. Rural affiliation influences the intent to practise rurally on graduation. The pre-outplacement perceptions, in this study, are comparable with post-outplacement observations reported in the literature.

Exploration of the factors that influence new Australian dental graduates to work rurally and their perspectives of rural versus metropolitan employment

INTRODUCTION

The challenges in the recruitment and retention of dentists in rural Australia have contributed to a lack of dental service provision to rural communities. This paper explores the workforce factors involved in the employment location decisions of dentists' post-graduation.

MATERIALS AND METHODS

Graduates between 2009 and 2013 from the University of Sydney, Dental School, were asked to complete a telephone interview related to their employment history. A total of 135 interviews were conducted, with 63% (135/214) of contactable graduates, or 33.4% (135/404) of all the graduates (2009-2013). Interviews followed a semi-structured script.

RESULTS

Key factors which positively impacted on rural employment included the following: job competition in metropolitan areas, good rural salaries, financial incentives, clinical experience, rural lifestyle and professional mentorship. Barriers were as follows: proximity to friends and family, building a social and professional network, isolation, less professional support and reduced access to education.

CONCLUSION

Recommendations to increase rural employment include: competitive rural salaries, financial incentives and formal mentorship during both recruitment and integration into a rural community. Dental schools should consider advertising identified drivers of rural employment, namely good salaries, full-time employment, clinical experience and rural lifestyle. This study provides important information related to rural employment and rural retention.

University-based initiatives towards better access to oral health care for rural and remote populations: A scoping review

This scoping review maps a wide array of literature to identify academic programs that have been developed to enhance oral health care for rural and remote populations and to provide an overview of their outcomes. Arksey and O'Malley's 5-stage scoping review framework has steered this review. We conducted a literature search with defined eligibility criteria through electronic databases, websites of academic records, professional and rural oral health care organizations as well as grey literature spanning the time interval from the late 1960s to May 2017. The charted data was classified, analyzed and reported using a thematic approach. A total of 72 citations (67 publications and seven websites) were selected for the final review. The review identified 62 universities with program initiatives towards improving access to oral health care in rural and remote communities. These initiatives were classified into three categories: training and education of dental and allied health students and professionals, education and training of rural and remote community members and oral health care services. The programs were successful in terms of dental students' positive perception about rural practice and their enhanced competencies, students' increased adoption of rural practices, non-dental health care providers' improved oral health knowledge and self-efficacy, rural oral health and oral health services' improvement, as well as cost-effectiveness compared to other strategies. The results of our review suggest that these innovative programs were effective in improving access to oral health care in rural and remote regions and may serve as models for other academic institutions that have not yet implemented such programs.

Influence of Community-Based Dental Education on Practice Choice: Preliminary Data from East Carolina University

Maldistribution of the dental workforce contributes to poor access to oral health care. Community-based dental education (CBDE) may help to address this problem by using experiential learning to encourage new dentists to practice in underserved areas. The East Carolina University School of Dental Medicine (East Carolina University SoDM) employs a multifaceted strategy, including CBDE, to increase the number of dentists practicing in underserved areas of North Carolina. The aim of this study was to assess the influence of CBDE and other factors on practice choice among East Carolina University SoDM graduates. This cross-sectional study assessed practice intentions before and after a senior-year CBDE experience. Data were obtained for students in three graduating years from written student reflections and self-reported practice plans solicited at graduation. Of the total 156 students between 2015 and 2017 (52 each year), all students participated in at least one component of this evaluation: all students (100%) completed required student reflections, and 148 (95%) provided pre-graduation practice plans. Data were also obtained on alumni practice characteristics via a survey of recent graduates; 72 alumni (46% response rate) participated in the alumni survey. The assessments found positive attitudes towards the CBDE program before and after participation, although areas for improvement relating to business management and financial viability were reported. The majority of alumni respondents (67%) remained in the state to practice after graduation, with half reporting practicing in rural areas. For most alumni respondents (>75%), debt, salary, benefits, type of patient population, and desire to own/run a business were important factors other than the CBDE program influencing their practice choice. Nearly half of them (45.8%) rated desire to work in a public health setting as an important factor. This study provides preliminary evidence of the effectiveness of this educational model in retaining new dentists within the state to address the critical shortage of dentists in North Carolina.

Adverse health events associated with clinical placement: A systematic review

OBJECTIVE

Clinical placement is a fundamental aspect of student learning and skill development across healthcare disciplines. However, participation in clinical placements can also present significant risk to students. This systematic literature review sought to examine the range of risks and hazards encountered by students across healthcare disciplines during their clinical placements.

DESIGN

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines were utilised in conducting this exploratory systematic review.

DATA SOURCES

The CINAHL Complete, Medline Complete, and PsycINFO databases were searched. Reference lists of eligible records obtained via database searching were screened, and a supplementary key author search was conducted. Research published between 2013 and 2018 and conducted in the context of comparative international healthcare systems was the focus of this study.

REVIEW METHODS

Study titles and abstracts were screened, and the full text of potentially relevant records was perused. Records meeting key eligibility criteria by addressing risk posed to students in healthcare disciplines within a clinical placement context were included in the final synthesis.

RESULTS

The search identified 46 eligible records. The literature highlighted the worrying trend that students, most notably in the nursing discipline, can be exposed to a wide range of risks and adverse health events during clinical placement.

CONCLUSIONS

As risks in unpredictable clinical environments cannot be eradicated, this review demonstrated a critical need for educative action to enable students to competently and confidently manage risks, and to reduce occurrence of adverse health events.

Rural placement experiences in dental education and the impact on professional intentions and employment outcomes-A systematic review

CONTEXT/INTRODUCTION

The availability of clinical dental services in rural locations is a major concern for many countries as dental care professionals gravitate to work in metropolitan areas. This systematic review examines the literature on Rural Placement Programs within dentistry and their impact on workforce intentions and employment outcomes. The review provides a detailed analysis of the methodological characteristics of the literature, considers the quality of the evidence and compares the outcomes within an international context.

MATERIALS AND METHODS

The systematic review identified published literature between 2005 and 2016 from databases including EMBASE, MEDLINE, PubMed, NursingOVID and Cochrane. The PRISMA protocol was adopted for the development of the study, and the Health Gains Notation Framework was implemented to assess the quality of the selected research papers.

RESULTS

Eleven studies considering Rural Clinical Placement Programs met the inclusion criteria. The studies were from Australia, South Africa, United States, Thailand and India. The evidence in this review indicates that well-designed, financially supported programmes that provide a perceived valuable clinical experience, good supervision and professional support in a rural environment can lead to dental students stating increased intentions to working in a rural location. However, there was a lack of evidence and research into whether these rural intentions result in positive action to take up employment in a rural location.

CONCLUSION

The evidence suggests that well-prepared rural clinical placements, which have experienced clinical supervisors, good professional student support from the dental school, provide a valuable clinical experience and are sufficiently funded, can increase intentions to work in a rural location upon graduation. However, there is a lack of evidence in dentistry into whether intentions translate into practitioners taking clinical positions in a rural location. Future research should be planned, which will undertake longitudinal cohort studies to identify factors that have an important influence on rural job choice.

Transformative effects of Aboriginal health placements for medical, nursing, and allied health students: A systematic review

The aim of the present systematic review was to investigate whether placements in Aboriginal health affect the self-perceived skill in working in Aboriginal health settings and career aspirations of health students, and in particular, aspects of the placement that had the greatest impact. The Embase, Cinahl, ProQuest, Scopus, Informit, Ovid MEDLINE, PsychINFO, and PubMed databases were searched in April/May 2016. Placements of at least 1 week duration in an Aboriginal health setting involving Australian students of medical, nursing, dentistry, or allied health disciplines, with outcomes relating to changes in students' knowledge, attitudes, and/or career aspirations, were included. The search retrieved 1351 papers. Fourteen studies were eligible for inclusion in this review. Narrative synthesis found that work placements in Aboriginal health increased understanding and awareness of Aboriginal culture, promoted deeper understanding of Aboriginal health determinant complexity, increased awareness of everyday racism toward Aboriginal Australians, and enhanced desire to work in Aboriginal health. There is a need for improved teaching and learning scholarship to understand whether placements improve students' skill working with Aboriginal people in health care or increase the likelihood of future employment in these settings.

Interventions for enhancing the distribution of dental professionals: a concise systematic review

BACKGROUND

A spatially unequal distribution of dentists or dental care professionals (D/DCPs), such as therapists or hygienists, could reduce the quality of health services and increase health inequities. This review describes the interventions available to enhance this spatial distribution and systematically assesses their effectiveness.

METHODS

Electronic databases (Cochrane CENTRAL, Medline, Embase, CINAHL) were searched and cross-referencing was performed using a standardised searching algorithm. Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series were included. Studies investigating a minimum of one of four interventions (educational, financial, regulatory and supportive) were included. The primary outcome was the spatial distribution of D/DCPs. Secondary outcomes were access, quality of services and equity or adverse effects. This review was registered (CRD42015026265).

RESULTS

Of 4,885 articles identified, the full text of 201 was assessed and three (all investigating national policy interventions originally not aiming to change the distribution of D/DCPs) were included. In one Japanese study spanning 1980 to 2000, the unequal spatial distribution of dentists decreased alongside a general increase in the number of dentists. It remained unclear if these findings were associated. In a second Japanese study, an increase in the number of dentists was found in combination with a postgraduate training programme implemented in 2006, and this occurred alongside an increasingly unequal distribution of dentists, again without proof of cause and consequence. A third study from Taiwan found the introduction of a national universal-coverage health insurance to equalise the distribution of dentists, with statistical association between this equalisation and the introduction of the insurance.

CONCLUSIONS

The effectiveness of interventions to enhance the spatial distribution of D/DCPs remains unclear.

A Community Engaged Dental Curriculum: A Rural Indigenous Outplacement Programme

BACKGROUND

Indigenous people worldwide suffer from poor oral health as compared to non-Indigenous citizens. One of the approaches to bring about improvement in Indigenous oral health is to enhance the service provision by implementing oral health outplacement programmes. A case study of such a programme for dental students in Australia reports how an educational institution can successfully engage with an Indigenous oral health service to provide learning experiences to the students as well as deliver much needed services to the community.

DESIGN AND METHODS

The assessment of this ongoing outplacement programme over the period of 2008-14, based on students' feedback, highlights some of the key beneficial outcomes. Students agreed that the Indigenous outplacement programme improved their understanding of Indigenous issues (mean ± SD: 4.10±0.8; 5 refers to strongly agree on 5-point scale) and increased the possibility that they will practise in Indigenous health (3.66±1.0). They were pleased with the assistance received by clinical supervisors and clinic staff at the Indigenous dental clinic (4.28±0.8).

CONCLUSIONS

This programme has demonstrated that structured student outplacements are valuable in building relations across cultures especially with Indigenous communities. It has also shown that university engagement with the public health sector can be beneficial to both institutions. Significance for public healthAn oral health outreach programme is one of the suggested approaches to effectively address the endemic issues of poor oral health among Indigenous people around the world. An Indigenous dental clinical outplacement in Australia provides an example of beneficial outcomes of such an approach. It provides dental students with an opportunity to experience the health issues related to Australian Indigenous communities and prepare future graduates to work comfortably in the public health care system. Indigenous people also develop trust and feel comfortable in receiving oral health care services from non-indigenous clinicians.

Undergraduate students' contributions to health service delivery through community-based education: A qualitative study by the MESAU Consortium in Uganda

BACKGROUND

It has been realised that there is need to have medical training closer to communities where the majority of the population lives in order to orient the trainees' attitudes towards future practice in such communities. Although community based education (CBE) has increasingly been integrated into health professions curricula since the 1990s, the contribution students make to service delivery during CBE remains largely undocumented. In this study, we examined undergraduate health professions students' contribution to primary health care during their CBE placements.

METHODS

This was a qualitative study involving the Medical Education for Equitable Services to All Ugandans consortium (MESAU). Overall, we conducted 36 Focus Group Discussions (FGDs): one each with youth, men and women at each of 12 CBE sites. Additionally, we interviewed 64 community key-informants. All data were audio-recorded, transcribed and analysed using qualitative data analysis software Atlas.ti Ver7.

RESULTS

Two themes emerged: students' contribution at health facility level and students' contribution at community level. Under theme one, we established that students were not only learning; they also contributed to delivery of health services at the facilities. Their contribution was highly appreciated especially by community members. Students were described as caring and compassionate, available on time and anytime, and as participating in patient care. They were willing to share their knowledge and skills, and stimulated discussion on work ethics. Under the second theme, students were reported to have participated in water, sanitation, and hygiene education in the community. Students contributed to maintenance of safe water sources, educated communities on drinking safe water and on good sanitation practices (hand washing and proper waste disposal). Hygiene promotion was done at household level (food hygiene, hand washing, cleanliness) and to the public. Public health education was extended to institutions. School pupils were sensitised on various health-related issues including sexuality and sexual health.

CONCLUSION

Health professions students at the MESAU institutions contribute meaningfully to primary health care delivery. We recommend CBE to all health training programs in sub-Saharan Africa.

Impact of initiatives to reduce public dental waiting lists in Queensland, Australia

Information on public dental service waiting lists is available as part of the Queensland Government open data policy. Data were analysed for the period December 2012 to December 2013, to present the total number and percentage of people waiting for care and who have waited beyond the desirable period. Over the 1-year study period, the number of people on the waiting list decreased from 130 546 to 77 146, a difference of 40.9%. A decrease of 80.6% was found for those waiting beyond the desirable period for care. The largest decrease was for general care (44.9%). The initiatives to reduce the public dental waiting list appear to have been successful in significantly reducing the number of people waiting in general and especially those waiting beyond the desirable period. The initiatives to decrease waiting lists represent a downstream approach and are less likely to have any significant impact on the prevention of oral diseases. As waiting lists are reduced, more emphasis should be placed on upstream approaches such as health promotion, specific protection measures and targeting high-risk individuals for oral diseases.