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Community-Based Dental Education and Service Learning. Dr shabeel pn Workshop Agenda. Welcome and Overview of Objectives Introduction to Service-Learning (SL) Models of SL in Dental Education Preparing Dental Students for Service in the Community.

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Community based dental education and service learning

Community-BasedDental Education and Service Learning

Dr shabeel pn

Workshop agenda

Workshop Agenda

  • Welcome and Overview of Objectives

  • Introduction to Service-Learning (SL)

  • Models of SL in Dental Education

  • Preparing Dental Students for Service in the Community

Workshop objectives

Workshop Objectives

1. Define service-learning (SL) and explain how it differs from and complements traditional clinical experiences in dental education;

2. Identify the key components of SL: curriculum development; community partnerships, community service, and reflection;

Workshop objectives1

Workshop Objectives

3.Describe how SL fosters student leadership, cultural competency, lifelong learning, and a commitment to caring for the underserved; and

4. Explore ways to develop a plan for incorporating SL into the dental education curriculum at the predoctoral or postdoctoral level

Trends shaping education and practice in health professions

Trends Shaping Education and Practice in Health Professions

  • Advances in diagnosis and treatment

  • Changing role of health care and education consumer

  • Demographic changes

  • Disparities in health access and outcomes

  • Broadened definition of health

Competences for the dentist of the 21 st century adea

Competences for the Dentist of the 21st Century (ADEA)

  • Participate in improving oral health

  • Provide empathic care for all patients

  • Evaluate social and economic trends

Competences for the dentist of the 21 st century adea1

Competences for the Dentist of the 21st Century (ADEA)

  • Assess patient goals, values, and concerns

  • Provide patient education

  • Obtain psychosocial and behavioral histories

Competences for the dentist of the 21 st century adea2

Competences for the Dentist of the 21st Century (ADEA)

  • Recognize signs of abuse or neglect and report and refer as necessary

  • Apply ethical principles

  • Evaluated career options, practice location, and reimbursement mechanisms

Competences for the dentist of the 21 st century adea3

Competences for the Dentist of the 21st Century (ADEA)

  • Recognize predisposing and etiologic factors

  • Manage dental care for disabled and special care patients

Dental school accreditation standards excerpts

Dental School Accreditation Standards (excerpts)

Graduates must be competent in:

  • Application of behavioral sciences

  • Patient-centered oral health promotion

  • Managing a diverse patient population

  • Skills for a multicultural work environment

Dental school accreditation standards excerpts1

Dental School Accreditation Standards (excerpts)

  • Evaluating models of oral health

  • Ethical reasoning, critical thinking, problem solving, life-long learning, self-assessment

Calls for change in the education of health professions 1990 2005

Calls for Change in the Education of Health Professions, 1990-2005

Advocating greater emphasis on community-based learning:

  • Pew Health Professions Commission

  • Council on Graduate Medical Education

  • IOM Report: Dentistry at the Crossroads

  • IOM Report: Future of Public Health

  • Surgeon General’s Report on Oral Health

  • New Initiatives Emphasizing Community-Based Dental Education

Trends shaping education and practice in health professions1

Trends Shaping Education and Practice in Health Professions

  • Expectations of accountability, involvement, relevance

  • Continued pressure on costs

  • Increasingly managed and integrated care

  • New technologies

Ccph mission

CCPH Mission

To foster partnerships between communities and educational institutions that build on each other’s strengths and develop their roles as change agents for improving education of health professionals, civic responsibility and the overall health of communities.



English Definitions:

-to help, a helpful act

-to benefit

-a contribution to the welfare of others

-disposal for use of the entire system

- use of labor that does not produce a

tangible commodity

-work that gives good

Service learning focuses on

Service-Learning Focuses On:

1. The context in which the service is provided;

2. The connection between the service and their academic course work; and

3. Their roles as professionals and citizens.

Sl is a type of experiential education a furco 1996

SL is a Type of Experiential Education (A. Furco, 1996)








ServiceFOCUS Learning

Theoretical underpinning of sl experiential learning theory d kolb 1984

Theoretical Underpinning of SL:Experiential Learning Theory –D. Kolb, 1984

Community based dental education and service learning

Service-Learning is NOT

the same thing as doing clinical

work in a community setting.

Clinical work in community settings

Clinical Work in Community Settings

  • Focuses almost exclusively on the delivery of dental services (technical competence) to patients in the community

  • Is not holistic

  • Emphasis on treatment, less on prevention

  • Tends to be a “top down”, hierarchical model

Points of departure sl and clinical education

Points of Departure: SL and Clinical Education

  • Balance between service and learning

  • Emphasis on addressing community-identified concerns and broad determinants of health

  • Integral involvement of community partners

Points of departure sl and clinical education1

Points of Departure: SL and Clinical Education

  • Emphasis of SL is on:

    • Reciprocal learning

    • Reflective practice

    • Developing citizenship skills

    • Achieving social change

Sl involves partnerships

SL Involves Partnerships

  • Partnerships:

    • Common missions, values, outcomes

    • Share mutual trust, respect and commitment

    • Acknowleges assets and needs

    • Balances power & shares resources

    • Have clear, open communication

    • Agree on roles, norms & processes

    • Do continuous quality improvement

    • Share credit for success

    • Develop/ripen over time

Benefits of sl for students

Benefits of SL for Students

  • Personal/interpersonal skill development

  • Communication skills

  • “The personal becomes the political”

Reflection in service learning

Reflection in Service Learning

  • Reflection is a bridge between experience and theory

  • John Deweydescribedreflection as “turning a subject over in the mind and giving it serious and consecutive considerations.”

Reflection in service learning bringle hatcher educational horizons 1999

Reflection in Service Learning(Bringle & Hatcher. Educational Horizons. 1999)

Is a learning strategy designed to

respond to limitations of traditional

student learning:

  • how to generalize prior learning to new circumstances or situations

  • promotes personal understanding

    of students’ lives and the world outside the


Reflection in service learning1

Reflection in Service Learning

Types of reflection for SL:

  • Journals are easy to assign and provide a way for students to express their thoughts of feelings about the service experience

    • Students need to know, at beginning of course, what is expected in a journal and how it is going to be used

    • If intended as personal document, not submitted for a grade

    • May be shared with other students or community agency personnel

Reflection in service learning2

Reflection in Service Learning

Critical incident journal:

Students focus on a specific event that occurred at the service cite in which a decision was made, a conflict occurred, or a problem was resolved. They are asked to describe the event, how it was handled, alternative ways in which they could have resolved the situation, and how they might act in a similar situation in the future (e.g., their thoughts, reaction, and future action). They may include information from the course that might be relevant to the incident.*

-Why was it such a confusing event?

-How did you/others around the event feel

about it?

-What did you do or 1st consider doing?

-List 3 actions that you might have taken and

evaluate each one.

An example of critical incident essay applied to dentistry mofidi et al 2003

An Example of Critical Incident Essay Applied to Dentistry: (Mofidi, et. al., 2003)

Excerpts from student essays


-”We truly have to imagine ourselves in the shoes of the person we are treating in order to best help them.”

-”I realize now that everyone deserves your compassion and no one deserves your judgment”

-”Are those who acquired this disease (AIDS) through risky behavior of their own doing not so worthy of my support [as unsuspecting victims]? I am not sure, but I will continue to examine my feelings.”

-”I learned that there is a greater need out there than I anticipated. And no matter how small a difference I make, it is still a difference. . . It is enough to make me try to make the difference.”

Reflection in service learning3

Reflection in Service Learning

  • Ethical Case Study. Write a case study of an ethical dilemma confronted at the service site, with a description of the context, the individuals, involved, and the controversy/dilemma observed

    -May be used for structured group

    discussion, provide basis for formal

    papers or class presentation

Reflection in service learning4

Reflection in Service Learning

  • Directed Readings

  • Class Presentations

    • Students share experiences, service accomplishments, products created during their service, using videos, PowerPoint, bulletin boards, panel discussions. Community present.

    • Provide opportunities for student to organize experiences, develop creative displays, share information.

Reflection in service learning5

Reflection in Service Learning

  • Electronic Reflection

    Web-based mode of communication (i.e., class home pages, chat rooms, on-line survey forms), e-mail, and class listservs to present material, structure discussions, submit reflective journal entries, and deal with issues at the service site

Community based dental education and service learning

SL Findingsbased on literature reviews and findings from the Health Professions Schools in Service to the Nation project HPSISN 1996-1998

Student Outcomes

-transformational learning experiences

-clarifications of values, sense of self

-awareness of determinants of health

-sensitivity to diversity

-knowledge of health policy issues

-leadership development

Sl findings student outcomes

SL Findings: Student Outcomes

Following a SL experience students in the health sciences reported better knowledge of:

  • Community resources

  • Health care needs of the community

  • Barriers to receiving care

  • Impact of socioeconomic status on health

    These findings were statistically significant

Sl findings student outcomes1

SL Findings: Student Outcomes

Following a SL experience students

Were more likely to report a

willingness to:

  • Work on a multiprofessional team

  • Work in a rural setting

  • Volunteer their time

    These findings were statistically significant

Sl findings student outcomes2

SL Findings: Student Outcomes

Following a SL experience students reported:

  • Feeling better prepared to work in community settings

  • Feeling more comfortable working with diverse patient populations

  • Greater commitment to work in HPSA’s and with diverse patient populations

Sl findings faculty outcomes

SL Findings: Faculty Outcomes

-Enhanced relationship between students

and community

-Linkage of personal/professional lives

-Better understanding of community issues

-New career and scholarship directions

-New directions and confidence in teaching

Sl findings community gains

SL Findings- Community Gains:

-Service, economic and social benefits

(access to experts for research, data analysis, program

evaluation, extended service delivery)

-Increased awareness of institutional


-high value placed on relationship with


-Value in being seen as teachers and


Sl findings academic institutions

SL Findings: Academic Institutions


  • Affirmation of mission and strategic goals

  • Better university-community relationships

  • Recruiting tool for students and faculty

Sl protocol for health professions schools

SL Protocol for Health Professions Schools

  • Include more community sites

  • Build long term relationships

  • Develop a Service Learning Experience

  • Develop an orientation component

  • Develop of reflection component

  • Promote the professional ethic of service

Risk management and sl

Risk Management and SL

Responsibilities of”

-Community Agencies


-The Institution

-The students

Lessons learned hpsisn 1996 1998

Lessons Learned(HPSISN* 1996-1998)

  • Service-learning is a powerful pedagogy

  • SL can contribute to key competencies

  • SL van benefit all stakeholders

  • Community can be effective educators

  • Community assets are often overlooked and underestimated

    *Health Professions Schools in Service to the Nation, a national demonstration program funded by Pew Charitable Trusts and the Corporation for National Service

Challenges sl is a process

ChallengesSL is a process…

  • Financial constraints of institutions

  • Rigid and over-loaded curriculum

  • Disciplinary boundaries

  • Lack of roles and rewards for innovation

  • Accepting the implications of true partnerships

  • Culture of needs-based and expert approaches

Strategies for sl

Strategies for SL

  • Review mission and strategic plan

    How can service-learning further both?

  • Review accreditation requirements

    How can service-learning enable you to meet them?

  • Review curriculum

    Where can SL enhance?

Strategies for sl1

Strategies for SL

  • Examine faculty roles and rewards policies

    What constitutes scholarship?

  • Invest in faculty development

  • Engage your community partners in a dialogue

  • Develop and promote principle-centered partnerships (CCPH Principles of Partnership)

Strategies for sl2

Strategies for SL

  • Assess and build on your strengths and assets

  • Create/enhance existing support structures

  • Collaborate across disciplines and campus

One example of sl the unc chapel hill sod experience in disc

One example of SL: The UNC Chapel Hill SOD Experience in DISC

Dentists in Service to Communities

Objective: to increase available oral health services to underserved peoples and communities

Funded by grant from KBR Charitable Trust initially for dental and dental hygiene students

  • 140 publicly owned, underserved sites in diverse communities (prisons, nursing homes, psychiatric hospitals, health centers, etc)

  • Rising sophomores, rising juniors, seniors

Disc at unc ch


  • At present, all UNC graduating dental students will have spent 47 days in extramural rotations. By 2006-07, this will become 60 days total with support of RWJ Dental Pipeline. Some students take summer externships for several additional months

  • All seniors spend 4 (soon 5) weeks each in a hospital rotation and a community rotation. In addition,

  • Rising sophomores and juniors are eligible for summer extramural elective rotations

  • Other extramural elective rotations are available to seniors when other requirements completed

Tangible results of disc

Tangible Results of DISC

  • Accomplishments in year 3:

    • Students treated 2,320 patients

    • 55% (1097) of these patients were children

    • Students produced $196,237 worth of dental services

    • Students evaluated all externships & sites and were evaluated by their preceptors on site

    • All students wrote reflective essays and participated in discussions

Disc at unc ch1



  • Dense curriculum/curriculum change

  • Timing and scheduling of courses

  • Elective vs. compulsory participation

    and how to maintain enthusiasm

  • Finding willing/qualified preceptors in student-selected sites (sometimes

  • Faculty “buy-in” around quality of education issues

Disc at unc ch2



  • Increase opportunities for students to experience clinical dentistry in underserved populations in their community context

  • Early exposure to ways to expand careers to broader and more diverse patients

  • Students further define career and ethical responsibilities to include service to the traditionally underserved and experience related rewards of public service

    And many other personal rewards in self awareness and spiritual terms

Disc program at unc ch

DISC Program at UNC-CH


  • Reflection—photo scrap books, critical incident essays, post-rotation discussions

  • SL exercise

  • Reading elective: all students read an assigned book related to social science theme. Past year was Nickled and Dimed by B. Ehrenreich) and write a reflective essay about it and meet together for discussion over dinner.

Preparation for working in the community

Preparation for Working in the Community

Need fornew curricular themesin addition to emphasis on technical competence

  • Communication skills to communicate effectively and comfortably with patients

  • A comprehensive (holistic) approach to understanding the social, economic and cultural context of the patient

  • Patient-centered care

  • Cultural sensitivity/competence



Role of social and behavioral sciences in the pre-clinical dental school curriculum

  • Teach students how to relate scientific principles and technical expertise with patient’s life history and clinical presentation

  • Teach concepts of culture, ethnicity and other key social variables

  • Be able to apply these concepts to the delivery of oral health care

  • Teach collaboration and group problem-solving



Need for new teaching strategies:

Traditional: Passive


Innovative: Active/Interactive/Discussion


Problem-based learning

Critical thinking/problem solving




New Instructional Methodologies

  • Scrap books/photos

  • Observation-Reflection: Writing (journals, critical incidents reports and essays)

  • Role Plays

  • Video

  • Collaboration: team-based projects and presentations

  • Readings humanities/social science



Clear expectations

-Communicated orally and in writing

-1 month before departure course director holds mandatory meeting (“send-off”) for students

-All necessary paperwork (critical incident log books, instructions, descriptions of all requirements and due dates, contact information for UNC personnel, needle-stick protocol on cards, etc)

For students, this structure provides certainty and boosts confidence in ability to function effectively away from the “mother ship”.

Re entry


Post-rotation reflection seminars: structured reflective experience

  • Revolve around feelings and issues associated with community-based experience

  • Discuss critical incidents with peers

  • Compare commonalities and differences

  • Groups of 8-10

  • 2 hours

  • Guided by trained dental faculty facilitator chosen by course director



  • Community-Campus Partnerships for Health


    • For training and technical assistance

    • CCPH Consultancy Network

    • Electronic and printed resources

    • Collaboration between CCPH and ADEA



  • Robert Wood Johnson Dental Pipeline Project

  • National Service-Learning Clearinghouse

Closing reflection

Closing Reflection

“I cannot know what your destiny will be, but one thing I do know is that the truly happy among you will be those who have learned to serve.”

Albert Schweitzer

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