Educational Solutions for Workforce Development Dentistry The Design, Implementation & Evaluation of...

Educational Solutions for Workforce Development

Dentistry

The Design, Implementation & The Design, Implementation & Evaluation of Cultural Competence Evaluation of Cultural Competence Training & Assessment in Dental Training & Assessment in Dental Vocational Training in ScotlandVocational Training in Scotland

L E Prescott-Clements


Dentistry

AimsAims

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


Dentistry

RACE

RELIGION

AGE

GENDER

DISABILITY

SEXUAL ORIENTATION

“OTHER”

Commn & Language

Courtesy & Respect

Avoiding Discrimination Clinical

Issues

Leadership & Management

Access Issues

Legislation

PRACTICAL SKILLS

ATTITUDES & BEHAVIOURS

KNOWLEDGE

Negative Assumptions

Training matrixTraining matrix


Dentistry

`RACE RELIGION AGE GENDER DISABILITYSEXUAL

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 - AssumptionsTheme - Assumptions


DentistryTraining formatTraining format

Half day introduction

Week 1

Learning outcomes

Didactic

Training Day

8 workshops

20 minutes

small groups (4 x ~ 20 trainees),


Dentistry

Stakeholder WorkshopsStakeholder Workshops

The Good Life Group

(Learning Disabilities)

Scottish Transgender

AllianceScottish Interfaith Council

Scottish Disability Equality Forum Ethnic

Minority / refugee

experiences


Dentistry

Role-play WorkshopsRole-play Workshops

Elderly Deaf patient

attends with carer

Employment Law scenario

(Racial Discrimination)

Inappropriate racial

remarks from a patient


Dentistry

AssessmentAssessment

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


Dentistry

ScenariosScenarios

•

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.


Dentistry

Sexual Orientation ScenarioSexual 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.


Dentistry

Scenario ResponseScenario Response

Lack of control of the situation

Slow response

Unaware of comments – attention or implications

Avoiding the issue

Chaperone issue


Dentistry

Impact EvaluationImpact Evaluation

Reaction

Learning

Performance

Outcome


Dentistry

Impact EvaluationReaction

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?


Dentistry

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

Good LifeGroup

ScottishTransgender

Alliance

ScottishInterfaithCouncil

Role Play[ElderlyPatient]

InnocentJakisa

ScottishDisability

Forum

Role Play[Dental

Nurse]

Role Play[Inappropriate

Remarks]

How much do you feel you learned?

Nothing

A lot


Dentistry

0

10

20

30

40

50

60

The Good LifeGroup

ScottishDisabilityForum

ScottishTransgender

Alliance

InnocentJakisa

ScottishInterfaithCouncil

Role Play -Dental Nurse

Role Play -Inappropriate

Remarks

Role Play -Elderly patient

Workshop

Yes

No

Will you change practice as a Will you change practice as a result?result?


DentistryHow will you change practice?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


Dentistry

How will you change practice?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


Dentistry

Impact Evaluation Impact Evaluation Learning and PerformanceLearning 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


Dentistry

EvaluationEvaluation

•

Attribution?

Patient Assessment Questionnaires

GDC cases

Complaints

MDDUS

Outcomes


DentistryRefinementsRefinements

•

No induction module

Training

Longer sessions

Smaller groups

More discussions, legislation and examples

New scenario

Assessment

Refine and add scenarios

Debrief


DentistryNext stage and beyondNext stage and beyond

•

Offered on an optional basis 09-10

Extended to include trainers & advisers

Digital design?

Resources?

Virtual patients?

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