Virtual patient instruction for dental students: can it improve dental care access for persons with special needs?

Health professionals' education related to people with intellectual and developmental disabilities: A scoping review

BACKGROUND

People with intellectual and developmental disabilities are among the most underserved in an inequitable healthcare system.

METHODS

Using Arksey and O'Malley's methodology and a social determinants of health framework, we conducted a scoping review of literature on the state of practice in education of healthcare professionals in the health and healthcare needs of this population.

RESULTS

Searches found 4948 articles, with 182 included in the final review. Themes identified included gaps of not being informed by workforce needs, continued use of the medical model of care, not addressing intersectionality with racial/ethnic and other discriminations, and lack of involvement of the population in developing/evaluating programs and promising trends of development of competency-based interprofessional programs with experiential learning.

CONCLUSION

We provide recommendations for best practices in a concerted effort to educate a healthcare workforce equipped with the knowledge and skills to address the health needs of this population.

Educational strategies for oral assistance for the disabled and their effects on dentistry students' formation: A systematic review

AIMS

This systematic review aimed to analyze the influence of educational strategies for oral health care for Persons with disabilities (PwDs) on the technical, ethical, and social training of undergraduate dental students.

METHODS AND RESULTS

An extensive search was performed in the following databases: Cochrane, Embase, PubMed, Scopus, Web of Science, LILACS/BBO and OpenGrey database. Observational, nonrandomized, and quantitative comparisons before and after some type of educational strategy in undergraduate dentistry was included. The risk of bias was assessed using the risk of bias in nonrandomized intervention studies (ROBINS-I) tool. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Nine were included and suggested that a significant improvement was observed in the technical training of undergraduate dental students although there was no consensus on the acquisition of ethical/social competences after the application of educational strategies. The included studies presented a moderate to serious risk of bias, and the certainty of evidence for both, technical and ethical/social evaluative constructs, as very low.

CONCLUSION

Although studies show that awareness regarding PwD significantly increases technical skills in dental students, the evidence is poor due to the high risk of bias and inconsistency observed in both the technical and ethical/social constructs; further studies on this topic are therefore essential. Prospero: (CRD42021288463).

A five-year cohort study on German dental students: Self-assessment in regard to previous experience and attitude toward patients with different types of disability

AIMS

In Germany, a curriculum in special care dentistry (SCD) is not mandatory. As a result, very little is known about dental students' attitudes toward interacting with people with disability (PwD). The study´s aim was to assess this among dental students at Witten/Herdecke University (UW/H).

MATERIAL AND METHODS

In the academic years 2016-2017 to 2020-2021, dental students in the 7th semester (UW/H) were asked to complete a self-assessment questionnaire. Prior to its start, the study had obtained a positive vote from the ethics committee of the UW/H (#174/2016).

RESULTS

Out of 199 students 166 persons on average 24.5 years old completed the questionnaire. Nearly all participants had already had previous experience with PwD in various domains of life prior to dental school (89.2%). Three-quarters indicated not having reservations about interacting with PwD. The proportion of persons without previous experience in interacting with a PwD was almost twice as high in the group with reservation (16.2%) as it was in the group without reservation (8.7%). Almost all surveyed students (92.8%) affirmed that they would like to learn more on the topic of "Professional Interaction with PwD."

CONCLUSION

Most of the respondents did not have reservations about interacting with PwD. Almost all the participants indicated a high level of interest in topics related to SCD. Also, the authors like to encourage the curriculum committees of dental schools at other universities to integrate courses on SCD, based on the iADH recommendations, into their dental curricula.

Educational strategies in oral healthcare for the disabled and their effects on dental students' training

PURPOSE

To evaluate the effects of didactic and clinical training of dental students in treating Persons with Disabilities (PwD) on their self-perceptions about treating PWD.

METHODS

A pre-and postevaluation of a didactic-clinical educational strategy targeting oral health care of PwD was conducted among fourth-year undergraduate dental students at a Brazilian dental school. Semi-structured questionnaires were used to assess the following work environment parameters: technical, organizational, social, ethical, and managerial acumen. Data were analyzed using Fisher's exact and chi-square tests, with a significance level of 5% (p < 0.05), to verify possible associations between the quantitative variables. A qualitative analysis was conducted through collective subject discourse.

RESULTS

Significant differences were found in the self-perception of students' knowledge and abilities in providing low-complexity care for PwD before and after the training program (p = 0.025). Students were more confident about managing and organizing the work environment (p = 0.007) and providing humanized care to PwD (p = 0.042) posttraining program. Additionally, a decrease in the feeling of insecurity (p = 0.014) and feelings of pity, fear, or prejudice toward PwD (p < 0.001) were observed posttraining program.

CONCLUSIONS

Didactic and clinical training interventions for treating PwD improved the work environment of undergraduate dental students in technical, managerial, organizational, and ethical/social dimensions.

Attitudes of dental students towards patients with special healthcare needs: Can they be improved?

INTRODUCTION

Lack of knowledge and skills as well as negative attitudes towards patients with special healthcare needs may adversely affect the services available to this group. In 2010, a line on the treatment of patients with special healthcare needs has been implemented in the dental curriculum at the Medical University of Vienna, including five seminars and a practical course. In this study, we examine to what extent the programme helps improve attitudes towards persons with special healthcare needs and positively impacts the readiness to engage in treating this clientele.

MATERIALS AND METHODS

In 2017 and 2018, all students who were in their fourth study year participated in the study. Students' attitudes were assessed before the first seminar, after the last seminar and after the practical course. At all three time points, the same fully structured questionnaire was used, including established instruments for the assessment of emotional reactions and the desire for social distance plus ad hoc questions for assessing students' future intention to treat patients with special healthcare needs. The data were analysed by means of linear fixed models.

RESULTS

At the end of the line devoted to patients with special healthcare needs, students tended less to express negative emotions and showed more positive emotional reactions than before the start of the programme. However, students' social acceptance of such patients and their readiness to engage in treating them did not change significantly.

DISCUSSION

While our programme was able to improve students' emotional reactions to people with special healthcare needs, it proved unable to reduce the desire for social distance and to lower the barrier when it comes to treatment. It is planned to further develop our programme which, hopefully, will then succeed in increasing students' readiness to treat this clientele.

CONCLUSION

Improving dental students' emotional reactions to patients with special healthcare needs does not necessarily translate into greater readiness to treat this clientele.

Supporting Empathy Training Through Virtual Patients

For the training of interpersonal skills, such as those required in the medical field, virtual agents can provide a safe environment for practice. However, many agent systems are not developed with the ability to understand non-verbal input. Being able to automatically parse such input is essential for the practice of interpersonal skills such as empathy. Currently, it is still an open question which prosodic or visual features would aid automatic classification of empathy and how this knowledge can be used to support the practice of these skills. As a first step towards this goal, we report on 42 second-year nursing students practicing their empathy skills with a virtual patient or through collaborative role playing. We found that across both the role playing and simulation, students assessed their empathy as increasing over time but as higher during the role playing. This work contributes to the continued development of virtual agents for the training of interpersonal skills.

Oral Health Status of Institutionalized Individuals with Intellectual Disabilities in Lebanon

OBJECTIVES

To assess the dental status of institutionalized intellectually disabled individuals in Lebanon and the role of background and behavioural determinants.

MATERIAL AND METHODS

Oral health was recorded for 652 individuals (6, 12, 15 and 35 - 44 years old) using the decayed, missing and filled teeth/decayed and filled teeth (DMFT/dft) index. Data collected was statistically analysed with statistical significance set at P = 0.05.

RESULTS

Overall, mean DMFT index score was 5.86 (SD 6); composed of 3.64 (SD 4.05) decayed (D) teeth; 1.71 (SD 4.38) missing (M) teeth; 0.87 (SD 2.51) filled (F) teeth. DMFT was highest in adults (12.71 [SD 7.43]) and had a large component of missing (6.24 [SD 7.02]) and filled (3.31 [SD 4.56]) teeth. DMFT scores ranged between 3.5 (SD 4.44) at 6 years and 4.8 (SD 4.52) at 15 years and the decayed component was the main contributor. In multivariate analyses, governorate of residence was statistically significantly (P ≤ 0.040 and P ≤ 0.044) associated with D and DMFT, the degree of disability and caretaker educational level were statistically significantly (P = 0.009 and P = 0.008) associated with D, oral hygiene practices were statistically significantly (P ≤ 0.017; P < 0.001; P ≤ 0.017; P < 0.001) associated with D, M, F and DMFT and sugar consumption was statistically significantly (P ≤ 0.03 and P ≤ 0.019) associated with D and DMFT.

CONCLUSIONS

In Lebanon, preventive and treatment programs to improve the oral health status of institutionalized intellectually disabled subjects are needed.

Design and evaluation of a simulation for pediatric dentistry in virtual worlds

BACKGROUND

Three-dimensional virtual worlds are becoming very popular among educators in the medical field. Virtual clinics and patients are already used for case study and role play in both undergraduate and continuing education levels. Dental education can also take advantage of the virtual world's pedagogical features in order to give students the opportunity to interact with virtual patients (VPs) and practice in treatment planning.

OBJECTIVE

The objective of this study was to design and evaluate a virtual patient as a supplemental teaching tool for pediatric dentistry.

METHODS

A child VP, called Erietta, was created by utilizing the programming and building tools that online virtual worlds offer. The case is about an eight-year old girl visiting the dentist with her mother for the first time. Communication techniques such as Tell-Show-Do and parents' interference management were the basic elements of the educational scenario on which the VP was based. An evaluation of the simulation was made by 103 dental students in their fourth year of study. Two groups were formed: an experimental group which was exposed to the simulation (n=52) and a control group which did not receive the simulation (n=51). At the end, both groups were asked to complete a knowledge questionnaire and the results were compared.

RESULTS

A statistically significant difference between the two groups was found by applying a t test for independent samples (P<.001), showing a positive learning effect from the VP. The majority of the participants evaluated the aspects of the simulation very positively while 69% (36/52) of the simulation group expressed their preference for using this module as an additional teaching tool.

CONCLUSIONS

This study demonstrated that a pediatric dentistry VP built in a virtual world offers significant learning potential when used as a supplement to the traditional teaching techniques.

Virtual patients in pharmacy education

A review of the literature relating to the use of virtual patients in teaching pharmaceutical care to pharmacy students was conducted. Only 7 articles met the inclusion criteria for the review and 4 of the studies were conducted in North America. Few articles identified by the review used virtual patient technology that was true-to-life and/or validated.

Computerized virtual patients in health professions education: a systematic review and meta-analysis

PURPOSE

Educators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and elucidate features of effective virtual patient design.

METHOD

The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, and Scopus through February 2009 for studies describing virtual patients for practicing and student physicians, nurses, and other health professionals. Reviewers, working in duplicate, abstracted information on instructional design and outcomes. Effect sizes were pooled using a random-effects model.

RESULTS

Four qualitative, 18 no-intervention controlled, 21 noncomputer instruction-comparative, and 11 computer-assisted instruction-comparative studies were found. Heterogeneity was large (I²>50%) in most analyses. Compared with no intervention, the pooled effect size (95% confidence interval; number of studies) was 0.94 (0.69 to 1.19; N=11) for knowledge outcomes, 0.80 (0.52 to 1.08; N=5) for clinical reasoning, and 0.90 (0.61 to 1.19; N=9) for other skills. Compared with noncomputer instruction, pooled effect size (positive numbers favoring virtual patients) was -0.17 (-0.57 to 0.24; N=8) for satisfaction, 0.06 (-0.14 to 0.25; N=5) for knowledge, -0.004 (-0.30 to 0.29; N=10) for reasoning, and 0.10 (-0.21 to 0.42; N=11) for other skills. Comparisons of different virtual patient designs suggest that repetition until demonstration of mastery, advance organizers, enhanced feedback, and explicitly contrasting cases can improve learning outcomes.

CONCLUSIONS

Virtual patients are associated with large positive effects compared with no intervention. Effects in comparison with noncomputer instruction are on average small. Further research clarifying how to effectively implement virtual patients is needed.