Are We Really Training Dentists to Treat Patients with Special Needs?

1. Are We Really Training Dentists to Treat Patients with Special Needs? • Author: Timothy B. Followell, DMD, MS • Institutions: The Ohio State University, Nationwide Children’s Hospital. Abstract Methodology Results Since the implementation of the pilot exam, there have been 156 dental students who have rotated through the Nisonger Center Dental Clinic. Of these students, 101 were eligible to challenge the competency exam. Of the students that were eligible to challenge the competency, 50 students completed the examination. Of these 50 students, there was one failure of the examination. The reason cited for failure was lack of understanding of the neurodevelopmental diagnosis. The student who failed the exam was able to remediate the exam that same day. Fifty one students who were eligible did not challenge the competency. Although the reason for not challenging the exam was not recorded, the most common reasons for not doing so were student absence, faculty absence, and patient cancellation/broken appointment. Individuals with special needs are often at higher risk for dental caries, yet dental students are often not required to show competence in treating patients with special needs. The Ohio State University requires its dental students to rotate through a program in which they perform clinical treatment for individuals who have intellectual or developmental disabilities. In addition, the College of Dentistry has created a novel competency examination that assesses the students’ ability to evaluate an individual with special needs and to plan appropriate treatment. The students who have challenged this pilot examination have passed at a high rate. Future plans include implementing this competency examination program-wide. The purpose and intent of the Nisonger Center Dental Program Competency Exam is to evaluate the dental student’s assessment of medical issues, limitations impacting treatment, and obtaining informed consent. It is critical for the dental student to assess the correct guardianship situation of each patient and to obtain appropriate informed consent and informed assent, when applicable. The dental student must understand the patient’s medical history, and understand any impact the patient’s health has on treatment considerations. In addition, the dental student needs to understand and address any physical limitations the patient may have to receiving dental treatment. The Competency Exam is a pass/fail exam that is still in the pilot stage. Currently, the exam is being administered by only one faculty member (Followell) to dental students on the Nisonger rotation. Each student spends approximately four clinic sessions at the Nisonger Center, and a student is eligible to challenge the competency on the third or fourth clinic session, after they have spent some time providing clinical treatment to individuals with special needs. If a student fails the exam, s/he is allowed to repeat the exam at the instructor’s discretion until the student exhibits satisfactory performance. Because the competency examination is still considered to be in the pilot phase, students were encouraged to complete the exam, but they were not penalized if they were unable to challenge the competency. Introduction Discussion Dental services are the largest unmet health care need for individuals with special needs.1 Casamassimo et al. found that only 10% of dentists frequently treat children with special needs, and only 25% of dentists recall having clinical experience treating patients with special needs in dental school.2In order to ensure quality dental education and This competency examination is aimed at fulfilling the CODA standards, but The Ohio State University has exceeded these standards by requiring each student to spend at least 32 hours in a clinic treating patients with special needs. The 98% pass rate among students who challenged the competency exam is hopefully an indicator that graduates of the program are well-prepared to treat individuals who have special needs. healthcare in the United States, the Commission on Dental Accreditation (CODA) publishes standards that every accredited dental program must follow.3These standards are written to protect the public and to improve the quality of oral health care. Dental and dental-related training programs are very intensive, and educators must make difficult choices in order to prioritize the most import components of didactic and clinical curricula. CODA defines patients with special needs as, “Those patients whose medical, physical, psychological, cognitive or social situations make it necessary to consider a wide range of assessment and care options in order to provide dental treatment. These individuals include, but are not limited to, people with developmental disabilities, cognitive impairment, complex medical problems, significant physical limitations, and the vulnerable elderly.” Unfortunately, due to the competing constraints placed upon the educational programs, CODA does not have a standard that requires dental students to be competent in treating individuals with special needs. Rather, CODA requires, “Graduates must be competent in assessing the treatment needs of patients with special needs.” Conclusion and Future Directions Many of the students were logistically unable to challenge the competency due to scheduling issues such as missed clinic sessions or attending cross-coverage. In the future, we anticipate expanding the competency to include additional attendings, both at the primary Nisonger Center Dental Clinic, and in the program’s satellite clinic. Although this competency exam assesses only the student’s ability to assess a patient and not to actually provide treatment, we anticipate that graduates of this program will be more likely to treat patients with special needs upon completion of this rotation. References NewacheckPW, McManus M, Fox HB, Hung Y-Y, Halfon N. Access to health care for children with special health care needs. Pediatrics 2000;105:76-766. Casamassimo PS, Seale NS, Ruehs K. General dentists’ perceptions of educational and treatment issues affecting access to care for children with special health care needs. J Dent Educ 2004;68:23-8. Accreditation Standards for Dental Education Programs. Commission on Dental Accreditation. Figure A. Competency Examination Form, Front and Back