1. Educational Solutions for Workforce Development Dentistry The Design, Implementation & Evaluation of Cultural Competence Training & Assessment in Dental Vocational Training in Scotland L E Prescott-Clements

2. Educational Solutions for Workforce Development Dentistry Aims 1.To develop & validate Cultural Competencies for Dentists in General Dental Practice. 2. To implement a programme of cultural competence training for Dental Vocational Trainees 3. To assess DVTs cultural competence using simulated patients within an OSCE format. 4. To evaluate the educational impact of the cultural competence training and assessment

3. Educational Solutions for Workforce Development Dentistry RACE RELIGION AGE GENDER DISABILITY SEXUAL ORIENTATION “OTHER” Comm n & Language Courtesy & Respect Avoiding Discrimination Clinical Issues Leadership & Management Access Issues Legislation PRACTICAL SKILLS ATTITUDES & BEHAVIOURS KNOWLEDGE Negative Assumptions Training matrix

4. Educational Solutions for Workforce Development Dentistry ` RACERELIGIONAGEGENDERDISABILITY SEXUAL ORIENTATION Not all individuals accessing dental care will speak English. Negative assumption that the individual does not speak English. Negative assumption that the individual is uneducated. Negative assumption that the individual will have poor dental health. Not all cultures attend regular check ups, rather only when there is a problem. Dentists should be pro-active in inviting regular attendance of such individuals. Some cultures ‘sharpen’ or remove teeth for cosmetic reason – dentists should investigate this sensitively. Some religions fast at certain times. Women from some religions (Hindu, Muslim, Orthodox Jewish & some Sikh women) may wish to be treated by an individual of the same sex, or to have a chaperone. Religious Holidays Negative assumption that older peoples’ opinions are less important and the practitioner ‘knows best’. Negative assumption that physical or communication problems are associated with mental difficulties. Negative assumptions around single mothers’ financial security. A wide range of disabilities exist, there is no fixed list. Areas include difficulties with MOBILITY, SIGHT, HEARING (or both), LEARNING DIFFICULTIES, and COMMUNICATION DIFFICULTIES. Wide range of information available on Fair for All website for all these groups. Negative assumption that physical or communication problems are associated with mental difficulties LGBT individuals may be reluctant to disclose their sexual orientation, or any info (e.g. medication) that may reveal this. Theme - Assumptions

5. Educational Solutions for Workforce Development Dentistry Training format  Half day introduction  Week 1  Learning outcomes  Didactic  Training Day  8 workshops  20 minutes  small groups (4 x ~ 20 trainees),

6. Educational Solutions for Workforce Development Dentistry Stakeholder Workshops The Good Life Group (Learning Disabilities) Scottish Transgender Alliance Scottish Interfaith Council Scottish Disability Equality Forum Ethnic Minority / refugee experiences

7. Educational Solutions for Workforce Development Dentistry Role-play Workshops Elderly Deaf patient attends with carer Employment Law scenario (Racial Discrimination) Inappropriate racial remarks from a patient

8. Educational Solutions for Workforce Development Dentistry Assessment  Implemented during month 8/9  North and West trainees  OSCE comprising 4 simulated patient cases  Trainee given short brief  Detailed scoring rubrics for assessment with performance indicators  Clinical and non-clinical assessors

9. Educational Solutions for Workforce Development Dentistry Scenarios  Patient (wheelchair user) attends 6 months following a major stroke. She has difficulty with speech and attends with her carer.  Inappropriate remarks made by the dental nurse in front of a gay patient, who is extremely offended.  Patient with mild Aspergers Syndrome attends for a check up.  Patient from the Church of the Latter Day Saints faith attends for a filling, but cannot have routine anaesthesia due to adrenalin component.

10. Educational Solutions for Workforce Development Dentistry Sexual Orientation Scenario  Dentist has completed the examination and re-enters the room.  Patient chats with dentist.  Dental nurse enters the room and chats with patient  Dental nurse makes offensive remarks  Series of opportunities for dentist to intervene.

11. Educational Solutions for Workforce Development Dentistry Scenario Response  Lack of control of the situation  Slow response  Unaware of comments – attention or implications  Avoiding the issue  Chaperone issue

12. Educational Solutions for Workforce Development Dentistry Impact Evaluation Reaction Learning Performance Outcome

13. Educational Solutions for Workforce Development Dentistry Impact Evaluation Reaction  Questionnaire to complete after each workshop How much do you feel you have learned? How useful was the information? How stimulating was the workshop? Please rate the discussions? How good a use of time? Would you change practice as a result?

14. Educational Solutions for Workforce Development Dentistry How much do you feel you learned? Nothing A lot

15. Educational Solutions for Workforce Development Dentistry Will you change practice as a result?

16. Educational Solutions for Workforce Development Dentistry How will you change practice? “Ask patients more about their individual needs” “Try to be less judgemental when it comes to any form of disability” “Ensure to take more time in understanding and not talking down to people” “Keep language simple but not patronising” Good Life Group

17. Educational Solutions for Workforce Development Dentistry How will you change practice? “More supportive of transgender people as I now understand better the issues they face with themselves” “Pass on the information to colleagues so that everyone knows the legal implications of disclosing gender history” “Be more open with pts and not be afraid to ask how they would like to be treated/ addressed. Scottish Transgender Alliance

18. Educational Solutions for Workforce Development Dentistry Impact Evaluation Learning and Performance Training was given to West region trainees only Both the North region trainees [control group] and the West region trainees were assessed. Compared assessment performance

19. Educational Solutions for Workforce Development Dentistry Evaluation  Attribution?  Patient Assessment Questionnaires  GDC cases  Complaints  MDDUS Outcomes

20. Educational Solutions for Workforce Development Dentistry Refinements  No induction module  Training  Longer sessions  Smaller groups  More discussions, legislation and examples  New scenario  Assessment  Refine and add scenarios  Debrief

21. Educational Solutions for Workforce Development Dentistry Next stage and beyond  Offered on an optional basis 09-10  Extended to include trainers & advisers  Digital design?  Resources?  Virtual patients?