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Development and Implementation of a New
Course Regarding Patients with Special
Health Care Needs
Stephanie M Munz,
MR Inglehart & RK Niemer
University of Michigan
SCDA Meeting 2014
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BACKGROUND
Focused Pre-doctoral Education in Special Care Dentistry
Is this a new phenomenon?
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How many schools teach this in the didactic curriculum?
How many schools have a clinical component?
How many schools have a dedicated clinic space?
How many dental schools have collaborative efforts with
other health care professional schools and programs?
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CODA Standard
 Standard 2-24 “Graduates must be
competent in assessing the treatment
needs of patients with special needs.”
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Development of a New Course
 Introduced as one course of three in a module
for third year dental students
 Many topics were previously addressed in separation
as aspects of other courses.
 Includes a subsequent clinical rotation
component at the adjacent University of
Michigan Health System in the Oral and
Maxillofacial Surgery/Hospital Dentistry Clinic
 Patients with special health care needs (SHCNs) are
often referred to the University of Michigan Hospital
Dentistry Clinic for comprehensive care when it is not
appropriate in a pre-doctoral clinic environment.
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Patients with disabilities:
Why do we talk about it?
 1st Reason: We all share some common
stereotypes that might work against
providing the best professional care for
persons with disabilities.
 most positive: Ulcer, Arthritis, Asthma, Diabetes, Heart
disease
 most negative: Mental illness, Alcoholism, Mental
impairment, Ex-convict, Tuberculosis
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Why?
 2nd Reason: These patients are likely to
have access to dental care issues. If you
don’t learn about these issues, you will
be less comfortable and less likely to
treat patients with SHCNs.
Dao, Zwetchkenbaum & Inglehart. General Dentists and Special
Needs Patients – Does Dental Education Matter?
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Education and ….
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Why?
 3rd Reason: Patients with disabilities
are likely to have
 More dental disease
 More missing teeth
 More problems finding dental care.
 Prevention is key!!!
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OBJECTIVES
 To assess attendance of classes, use of
podcasts and aspects of the new course that
are evaluated as helpful at the midterm time
of the class.
 To assess how well the students evaluate
their educational experiences in classroom,
clinic and community settings,
 which topics are seen as interesting vs. not
interesting and how interested the students are
in the topics presented, and
 which attitudes they hold concerning these
issues.
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METHODS
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Respondents: Data were collected from two separate classes of third
year dental students.
 Midterm data were collected from 40 students in the Winter term
and from 55 students in the Spring/Summer term course.
 End of term data were collected from 84 students in the Winter
Term and from 31 students in the Spring/Summer term course.
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Procedure: Data were collected with anonymous web-based surveys
at the midterm and end of the two semesters.
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Educational intervention:
 The class consisted of 14 sessions.
 The lectures focused on specific patient groups and their
management.
 Cases and guest speakers in their respective disciplines and a
guest patient speaker were included.
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MATERIALS
 The midterm survey consisted of 2 closed and 4 open ended
questions concerning attendance, use of podcasts, and aspects
of the course that were useful/ not useful.
 The end survey consisted of 20 closed ended questions
concerning
 interest in the course overall as well as in learning about specific
patient groups,
 evaluation of how well their education had prepared them to treat
patients with SHCNs and medical complexity,
 attitudes towards providing care for these patients,
 confidence when doing so, and
 challenges they perceive.
 In addition, 4 open ended questions inquired about aspects of the
class that were useful / not useful.
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Results - Objective 1
 Objective 1 was to assess attendance of classes,
use of podcasts and aspects of the course that are
evaluated as helpful at the time of the midterm.
 Only 15% of the students in class 1 and 42% in class
2 attended all lectures until the midterm.
 Of those students who did not attend, only 13% in
class 1 and 13% in class 2 listened to the podcasts of
all classes they missed.
 When asked what were helpful aspects of the class
 26% indicated attending lectures
 23% chose powerpoint slides and cases / examples and
 11% named podcasts.
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Results – Objective 2a
Evaluation of educational experiences
 Objective 2a was to assess how these
students evaluated the quality of their
classroom based, clinical and
community based education
concerning providing care for patients
with SHCNs and for medically complex
patients at the end of the term.
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Results – Objective 2a
Evaluation of educational experience
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Results – Objective 2b
Interest in topics
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Results – Objective 2b
Interest in topics – Open ended
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Results – Objective 2c Attitudes
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LESSONS LEARNED
 Overall, results showed students were not very
interested in the topics.
 Of these, patients with developmental
disabilities and head/neck cancer were most
interesting.
 Patients with medical complexity and mental
illnesses were least interesting due to
reported repetition of this material.
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LESSONS LEARNED
 Students reported they would appreciate
learning about these topics in hands-on
clinical settings rather than in a didactic
setting.
 Nevertheless, they reported high
satisfaction when hearing directly from
patients about their diagnoses and
experiences.
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Emphasize Practice Enhancing Skills
 Gain referrals from
physicians
 Become a consulting
source for your local
hospital/urgent care
 Treat one special
patient, treat their entire
family and all their
friends and neighbors
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RECOMMENDATIONS
 In the future, case discussion and application should
be further incorporated for preparation and
competence in the clinical environment.
 While a two-week clinical rotation already exists in the
pre-doctoral curriculum, improved preparation for and
integration of this rotation is recommended and
achievable.
 The addition of the Delta Dental of Michigan Integrated
Special Care Clinic for the treatment of patients with
SHCNs will augment this ability to apply didactic
knowledge to the treatment of patients.
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CONCLUSIONS
1. Lack of student interest in the topics of patients with
SHCNs and medical complexity is likely due to
“lecture fatigue” as well as repetition of some
material in the curriculum.
2. Active learning models, including case discussion
and application should be incorporated for
increased engagement.
This can be used to
emphasize the importance of this aspect of dentistry
as well as increase students’ levels of competence
and confidence.
3. Collaboration with other health care professionals in
a subsequent, sustained clinical experience will also
increase clinical competence and confidence,
making it more likely that graduates will pursue
treatment opportunities for patients with SHCNs.
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REFERENCES
1.
2.
3.
4.
5.
Chavez EM, Subar PE, Miles J, Wong A, Labarre EE, Glassman P.
Perceptions of predoctoral dental education and practice patterns in
special care dentistry. J Dent Educ. 2011 Jun;75(6):726-32.
Dao LP, Zwetchkenbaum S, Inglehart MR. General dentists and special
needs patients: does dental education matter? J Dent Educ. 2005
Oct;69(10):1107-15.
Greig V, Sweeney P. Special care dentistry for general dental practice.
Dent Update. 2013 Jul-Aug;40(6):452-4, 456-8, 460.
Krause M, Vainio L, Zwetchkenbaum S, Inglehart MR. Dental education
about patients with special needs: a survey of U.S. and Canadian dental
schools. J Dent Educ. 2010 Nov;74(11):1179-89.
Subar PE, Chavez EM, Miles J, Wong A, Glassman P, Labarre EE. Preand postdoctoral dental education compared to practice patterns in
special care dentistry. J Dent Educ. 2012 Dec;76(12):1623-8.
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ACKNOWLEDGEMENTS
* This research was initiated as an evaluation of a newly designed predoctoral didactic course aimed at comprehensive clinical
management of the adult patient with special health care needs and
medical complexity at the University of Michigan – School of Dentistry
and in conjunction with the third author’s affiliation with the University
of Michigan Center for Research on Learning and Teaching.
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Questions or comments are welcome:
smmunz@med.umich.edu
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