1. Interprofessional Oral Health Education in Medical Student Curriculum Hope Cherry, BS, CHES; Tracey Smith, DNP, PHCNS-BC, MS; Poonam Jain, MPH, BDS, MS; Jordan Orr MSIII; Christopher Tookey MSIII

2. Disclosures Tracey Smith: PI (MMC and SJH for Enos Park Access Program); IEMA for Radon Research

3. Objectives 1.Evaluate the usefulness of oral health education in medical student curriculum 2.Demonstrate and practice the basics of an oral health exam in the clinical setting 3.Identify potential areas within their own institution’s curriculum to incorporate oral health and interdisciplinary opportunities for oral health training and education

4. Why Oral Health?

5. Oral health means much more than healthy teeth. Oral health is integral to general health and well being. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

7. Oral Systemic connections To achieve good overall health, patients need to have good oral health According to the Surgeon General's Report in 2000: –Dental care is the most common unmet health need. –Oral disease can severely affect systemic health. –Much oral disease is preventable or at least controllable. –Profound disparities in oral health and access to care exist for all ages.

8. National Need: Twofold issue Go to ED Physicians aren’t trained in oral health Unlike ED, dentists can turn patients away 830,590 ED visits nationally Average ED cost $300 million for the three top dental complaints Cohen LA. Expanding the Physician’s Role in Addressing the Oral Health of Adults. American Journal of Public Health. 2013;103(3):408-412. doi:10.2105/AJPH.2012.300990.

9. How National Need being met AAMC published a report calling for oral health to be integrated into medical school curricula In order for communication and patient referral to improve, professions made be aware of one another’s practices Report IX. Contemporary Issues in Medicine: Oral Health Education for Medical and Dental Students. Association of American Medical Colleges. June 2008.

10. SIU-SOM Need LCME Curriculum tracking –2013/2014 No hits in curriculum for “oral health”, “dental health”

11. How SIU-SOM Need was met 2014-2015 4 th Year FM Elective –Smiles for Life –Shadowing dentist –Clinical assessment –Reflection with dental school faculty (Jain) 2015-2016 3 rd Year FM Clerkship –*Required for all* –1hr Lecture on medical/oral relationship –1hr demonstration of clinical skills and common dental complaints –Faculty observed student exam on oral exam, with preceptor

12. Key concepts for curriculum Basic oral anatomy review (some Y3, more Y4) Common diseases / injuries (Y3, Y4) When to treat vs when to refer (some Y3, more Y4) Get comfortable with oral health (Y3, Y4) –Think to ask questions –Think to examine mouth/gums/teeth

13. Specific resources used

14. Specific Resources Used (see handouts) Source: Dr. Jain, SIU SDM Source: American Dental Association

15. SIU-SOM Evaluation methods - Elective 5-question elective evaluation –Separate from school-wide elective evaluation –Was used to assess Usefulness of elective/materials for preparing for future practice Beneficial experiences Suggested improvements Caries Risk Assessment –Was used to assess Students’ ability to identify whether patients were at risk for dental caries –Patient and student names removed

16. Elective Evaluation Results How would you rate the usefulness of this elective in preparing you for your future practice? Excellent10 Very Good10 Good0 Fair0 Poor0 20 responses –2014-2015 –July 2015- December 2015 Qualitative analysis performed on short answer responses –Keywords identified

17. Elective Evaluation Results continued What (if anything) was most beneficial to you? “Dentist” / “Dental office”9 “Modules”/ “Smiles for Life”8 General health knowledge (“common complaints”, “sequelae of oral diseases/injuries”)8 Seeing patients in clinics (“patients”, “clinic”, “oral health in the area”)6 “Referrals” / “Insurance”2 What (if anything) was least beneficial to you? “All was beneficial” / “N/A”11 “Clinical Assessments”6 “Dentist”1 “Modules”1 “Reflection paper”1 -The Smiles for Life modules were actually fairly concise and high yield for information that I had little knowledge of at the beginning. Really valuable to have actual experience with a dentist. -[I enjoyed] learning more about oral health which is poorly (if at all) taught during the previous 4 years. -It was a little awkward performing the CAT (clinical assessment tool) assessments, but they were still a useful experience.

18. Elective Evaluation Results continued Is there anything you wish was covered in the elective that is not currently covered? “Nothing” / Comprehensive16 “Oral Cancer Screening”1 “Observe fluoride treatment by physician”1 “Insurance”1 “Referrals for cosmetic dentistry”1 What other materials/experiences/assignments would be useful to this elective? “All was beneficial” / “N/A”14 More time with dentists3 “Oral Cancer Screening”2 “Review of basic anatomy”1 “Procedures dentists often perform”1 “Experience with private and public dentists”1 -I found myself using Google for simple anatomy and further clarification that was helpful; I wish I would have probed Dr. Looker more during my time to help make sure I was doing a sufficient oral exam.

19. Elective Evaluation Results continued Assuming 4th year is too late, where do you think an appropriate place in the curriculum would be to learn about this topic? 2 nd Year11 3 rd Year / Clerkship8 4 th Year5 1 st Year4 - I think A&P and pathology of oral health could be better worked into 2nd year. Oral health exams and screening training would be good in family medicine clerkship 3rd year.

20. Caries Risk Assessment Results Age Range Low Risk Moderate Risk High Risk Total 0-61179 >60103242 Low Risk = only conditions in “Low Risk” column present Moderate Risk = only conditions in “Low” and/or “Moderate Risk” columns present High Risk = one or more conditions in the “High Risk” column present.

21. SIU-SOM Evaluation methods - Clerkship Clerkship Evaluation of presentations –Was used to assess Usefulness of session Quality of teaching If session should be continued after curriculum changes Pre-Post Quiz

22. Clerkship Evaluation Results Rate the usefulness of the session. (1-5 Likert) 12345 Oral Health in Primary Care 0.00% 33.33%58.33%8.33% Oral Health Assessments 0.00%16.67%41.67% 0.00% Rate the quality of teaching of the presenters. (1-5 Likert) 12345 Oral Health in Primary Care (Dr. Jain) 0.00% 33.33%50.00%16.67% Oral Health Assessments (Dr. Schlosser) 0.00%16.67%41.67% 0.00% Should this session be continued next year despite curriculum changes? YESNO Oral Health in Primary Care 100.00%0.00% Oral Health Assessments 66.67%33.33%

23. Results Rationale Possible reasons for low results –Initial implementation was clunky –Students may not have seen the need Student Feedback

24. Pre-Post Quiz Results (see handout) Percent Correct Pre-test vs Post-test PREPOST # of Responses3621 q116.7%23.8% q269.4%90.5% q3100.0% q461.1%90.5% q575.0%66.7% q697.2%95.2% q761.1%66.7% q816.7%23.8% q944.4%42.9% q1063.9%52.4% How confident are you… (Not confident = 1; Very confident = 5) PREPOST # of Responses3621 Talking to a patient about the importance of oral health? 2.50003.6667 Teaching patients proper oral hygiene? 2.80003.8095 Recognizing when a patient should be referred to a dentist? 2.66673.7143 Identifying oral cancer or precursor lesions like oral leukoplakia? 2.22223.0000 Recognizing risk factors for dental caries? 2.55563.5238 Answering patient questions about dental coverage? 1.41672.2857 Counseling patients with missing teeth and/or dentures? 1.62862.5714

25. Results Rationale All confidence levels increased Some knowledge areas decreased –Need continuous information throughout clerkship Student feedback

26. Interdisciplinary Approaches Systems Change Catalyst Utilize dentists in curriculum Dentists teach medical students Dentists teach faculty Preceptors experience oral exam with students Short-term improvements Medical students learn oral health Faculty/Preceptors can implement minor changes to practice Faculty/Preceptors can teach medical students Long-term improvements Medical students implement into future practice Better relationship between practices Improve Patient Outcomes

27. Key concepts for curriculum Basic oral anatomy review (some Y3, more Y4) Common diseases / injuries (Y3, Y4) When to treat vs when to refer (some Y3, more Y4) Get comfortable with oral health (Y3, Y4) –Think to ask questions –Think to examine mouth/gums/teeth

28. Discussion

29. References Cohen LA. Expanding the Physician’s Role in Addressing the Oral Health of Adults. American Journal of Public Health. 2013;103(3):408-412. doi:10.2105/AJPH.2012.300990. Report IX. Contemporary Issues in Medicine: Oral Health Education for Medical and Dental Students. Association of American Medical Colleges. June 2008. Smiles for Life: A National Oral Health Curriculum. http://www.smilesforlifeoralhealth.org/ http://www.smilesforlifeoralhealth.org/ Caries Risk Assessment Form. American Dental Association. 2011. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

30. Questions? Contact Hope Cherry at hcherry@siumed.eduhcherry@siumed.edu

31. Acknowledgements Thank you to Drs. Jain, Schlosser, Looker, Burris, Floyd, Renken, and Capati for their education to our students

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