Annualization of Fifth-Year Clinical Training in Dentistry: A Curricular Experience at the University of Costa Rica

The authors describe the impact of the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program on the development, growth, and expansion of general and pediatric dentistry residency programs in the United States. They first briefly review the legislative history of the Title VII program as it pertains to dental education, followed by a historical overview of dental education in the United States, including a description of the differences between dental and medical education and the routes to professional practice. The authors then present an extensive assessment of the role of the Title VII grant program in building general and pediatric dental training capacity, diversifying the dental workforce, providing outreach and service to underserved and vulnerable populations, stimulating innovations in dental education, and engaging collaborative and interdisciplinary training with medicine. Finally, the authors call for broadening the scope of the Title VII program to allow for predoctoral training (dental student education) and faculty development in general and pediatric dentistry. In doing so, the Title VII program can more effectively address current and future challenges in dental education, dentist workforce, and disparities in oral health and access to care.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Medical ethics has created contentious issues and requires reforms in medical education such as renewed emphasis on formal instruction. The aim here was to review the current status of bioethics teaching in medical schools, determine Saudi students’ perception of its coverage in the formal curriculum and make recommendations. Using a self-administered questionnaire in a cross-sectional study, undergraduate students’ opinion about medical ethics coverage was obtained. Fourteen clinical departments and 201 students were studied. Only 46% of respondents were satisfied with the current coverage of ethical issues in the formal curriculum; 23% were unaware of the value of the subject. Students’ approval rate was highest in Neurology and Psychiatry (70%). The study confirmed inadequate formal instruction on medical ethics in a developing country. Five recommendations are made. At admission, students’ integrity and character should be assessed. Bioethics should be taught in clinical settings. In the Islamic world, medical curricula should include the Islamic code of medical ethics. Peers, nurses and patients should evaluate graduates’ performance in ethics at the bedside. Evidence-based assessment and continuous quality improvement are required to maintain the requisite standard.

Background: A comprehensive search of the literature published between 2001 and 2010 was performed to gain a greater understanding of curricular reform practices at Chinese medical schools. Summary: There were 10,948 studies published between 2001 and 2010 that were retrieved from the database. Following preliminary screening, 76 publications from 49 different medical schools were selected. Thirty-one publications regarding clinical medicine curricular reforms were analyzed further. Of the 76 studies, 53 described curricular reforms that were instituted in theoretical courses, 22 described curricular reforms that were instituted in experimental courses, and 1 described curricular reforms that were instituted in a clinical skills training course. Of the 31 clinical medicine publications, 2 described reforms that were implemented for 3-year program medical students, 12 described reforms that were implemented for 5-year program medical students, 6 described reforms that were implemented for 7-year program medical students, and 2 described reforms that were implemented for 8-year program medical students. Currently, the majority of medical schools in China use the discipline-based curriculum model. Thirteen studies described transition to an organ-system-based curriculum model, 1 study described transition to a problem-based curriculum model, and 3 studies described transition to a clinical presentation-based curriculum model. In 7 studies educators decided to retain the discipline-based curriculum model while integrating 1 or several new courses to remedy the weaker aspects of the traditional curriculum, in 7 studies educators decided to integrate the preclinical courses with the clinical courses by using the systemic-integrating curricular system that dilutes classical disciplines and integrates material based on organ systems, and in 2 studies educators limited reforms to clinical courses only. Eight studies discussed the implementation of a formative evaluation system, 4 studies discussed faculty training, and 15 studies discussed the application of various instructional methods. Other issues that were also addressed include enhancing research, improving patient–doctor communication, developing interpersonal and teamwork skills, cultivating independent lifelong learning habits, and improving problem-solving capabilities. Conclusions: The medical schools in our study have adopted various comprehensive curricular changes, moving from a knowledge-based to a competency-based model, and from traditional standards to international standards. Many institutions face challenges when implementing curricular reforms, such as what to integrate and how to do so, the unintended omission of important material, ensuring coordination between different organizations and departments, and the training of faculty.

Little is known about how well faculty at teaching hospitals role-model behaviors consistent with cost-conscious care. We aimed to evaluate whether residents and program directors report that faculty at their program consistently role-model cost-conscious care, and whether the presence of a formal residency curriculum in cost-conscious care impacted responses. Cost-conscious care surveys were administered to internal medicine residents during the 2012 Internal Medicine In-Training Examination and to program directors during the 2012 Association of Program Directors in Internal Medicine Annual Survey. Respondents stated whether or not they agreed that faculty in their program consistently role-model cost-conscious care. To evaluate a more comprehensive assessment of faculty behaviors, resident responses were matched with those of the director of their residency program. A multivariate logistic regression model was fit to the outcome variable, to identify predictors of responses that faculty do consistently role-model cost-conscious care from residency program, resident, and program director characteristics. Responses from 12,623 residents (58.4 % of total sample) and 253 program directors (68.4 %) from internal medicine residency programs in the United States were included. The primary outcome measure was responses to questionnaires on faculty role-modeling cost-conscious care. Among all responses in the final sample, 6,816 (54.0 %) residents and 121 (47.8 %) program directors reported that faculty in their program consistently role-model cost-conscious care. Among paired responses of residents and their program director, the proportion that both reported that faculty do consistently role-modeled cost-conscious care was 23.0 % for programs with a formal residency curriculum in cost-conscious care, 26.3 % for programs working on a curriculum, and 23.7 % for programs without a curriculum. In the adjusted model, the presence of a formal curriculum in cost-conscious care did not have a significant impact on survey responses (odds ratio [OR], 1.04; 95 % Confidence Interval [CI], 0.52-2.06; p value [p] = 0.91). Responses from residents and program directors indicate that faculty at US teaching hospitals were not consistently role-modeling cost-conscious care. The presence of a formal residency curriculum in cost-conscious care did not impact responses. Future efforts should focus on placing more emphasis on faculty development and on combining curricular improvements with institutional interventions to adapt the training environment.

Tutor-supported comprehensive care training at the University of Bern School of Dental Medicine (SDM) has been used for many years. Therefore, the aim of this study was to evaluate dental students’ opinions on tutor-supported training to identify key aspects of future course organisation that are important for students to achieve the minimum requirements for their graduation. A digital survey was developed and distributed among all fourth- and fifth-year dental students enrolled in the SDM in 2014 and 2016. A total of 28 (41.2%) and 21 (36.2%) students participated in the survey in 2014 and 2016, respectively. The average age of all respondents was 25.8 (±4.0) years. The proportion of females was 75% with no differences between groups, neither among classes nor years of the survey. The students felt well prepared following the bachelor’s degree pre-clinical programme and a two-week introduction immediately preceding the clinical course. During clinical training, the students’ experiences with their assigned tutors were positive even though waiting times for tutors during patient care as well as organisational efforts to manage attestations and logbooks were mentioned. For each discipline, patient assignment (rho=0.54, p<0.0001) and frequently meeting with their tutors (rho=0.56, p<0.0001) revealed the highest correlation with 1) achieving minimum requirements and 2) improving treatment planning skills in both fourth- and fifth-year dental students. In conclusion, tutor-supported comprehensive care training is well accepted by dental students while focusing on both patient assignment and frequent discussions with tutors may help students to better achieve minimum requirements in clinical dental education.
 Accepted for publication: September 5, 2022
 Published online: September 8, 2022

Tutor-supported comprehensive care training at the University of Bern School of Dental Medicine (SDM) has been used for many years. Therefore, the aim of this study was to evaluate dental students' opinions on tutor-supported training to identify key aspects of future course organisation that are important for students to achieve the minimum requirements for their graduation. A digital survey was developed and distributed among all fourth- and fifth-year dental students enrolled in the SDM in 2014 and 2016. A total of 28 (41.2%) and 21 (36.2%) students participated in the survey in 2014 and 2016, respectively. The average age of all respondents was 25.8 (±4.0) years. The proportion of females was 75% with no differences between groups, neither among classes nor years of the survey. The students felt well prepared following the bachelor's degree pre-clinical programme and a two-week introduction immediately preceding the clinical course. During clinical training, the students' experiences with their assigned tutors were positive even though waiting times for tutors during patient care as well as organisational efforts to manage attestations and logbooks were mentioned. For each discipline, patient assignment (ρ=0.54, p<0.0001) and frequently meeting with their tutors (ρ=0.56, p<0.0001) revealed the highest correlation with 1) achieving minimum requirements and 2) improving treatment planning skills in both fourth- and fifth-year dental students. In conclusion, tutor-supported comprehensive care training is well accepted by dental students while focusing on both patient assignment and frequent discussions with tutors may help students to better achieve minimum requirements in clinical dental education.

Objectives: The objectives of this study are three-fold. First, to highlight areas of shortage in postgraduate dental education in Nigeria, secondly to propose the introduction of dental advisors into our postgraduate dental training and thirdly, to propose a model that could aid such dental advisors in predicting postgraduate dental training choice among Nigerian dental graduates. It is hoped that such a model would have enough predictive powers to aid would-be dental advisors in guiding fresh dental graduates aright in their choice of postgraduate dental training. Methods: Participants were dentists attending compulsory continuing professional development events at different centres across Nigeria. Graded Likert responses of 16 potential predictors of dental postgraduate training choice were obtained through self-administered questionnaires filled by 112 Nigerian dentists (mean age of 35.21 years ± 8.21). Data were analyzed after necessary recodes to allow for meaningful statistical analysis. The predictive power of each factor was determined by inter-specialty and intra-specialty comparisons. Results: A total of 51 males and 61 females participated in the study with predictors rated from 2.29 ± 1.23 to 4.09 ± 1.04. Diagnostic challenge strongly predicted a choice of Oral and maxillofacial surgery. Affluence and income jointly predicted choices of orthodontics and restorative dentistry while the female gender predicted a choice of pediatric dentistry. (P=<0.001). Work-life balance influenced a choice of preventive dentistry-related specialties in combination with other factors. Periodontology had several unique predictors. Conclusions: Income, work hours, private practice opportunity and affluence were stronger predictors than skills and course content in this study. There's a gradual shift from an oral surgery predilection to restorative dentistry. A female predilection for pediatric dentistry and male predilection for oral surgery persist. Endangered specialties like periodontics, prosthodontics justify a call office of postgraduate dental advisors in Nigerian postgraduate dental training to avert the looming dental training manpower crisis

PurposeDiabetes is a risk factor for COVID-19 severity, but the role played by glucose lowering medications (GLM) is still unclear. The aim of this study was to assess infection rates and outcomes of COVID-19 (hospitalization and mortality) in adults with diabetes assisted by the Local Health Unit of Padua (North-East Italy) according to the ongoing GLM.Patients and MethodsPeople with diabetes were identified using administrative claims, while those with SARS-CoV-2 infection were detected by cross referencing with the local COVID-19 surveillance registry. A multivariate logistic regression model was used to verify the association between GLM classes and the outcome.ResultsSARS-CoV-2 infection rates were marginally but significantly higher in individuals with diabetes as compared to those without diabetes (RR 1.04, p = 0.043), though such relative 4% increase may be irrelevant from a clinical and epidemiological perspective. 1923 individuals with GLM-treated diabetes were diagnosed with COVID-19; 456 patients were hospitalized and 167 died. Those treated with insulin had a significantly higher risk of hospitalizations for COVID-19 (OR 1.48 p < 0.01) as were those treated with sulphonylureas/glinides (OR 1.34, p = 0.02). Insulin use was also significantly associated with higher mortality (OR 1.90, p < 0.01). Use of metformin was significantly associated with lower death rates (OR 0.62, p = 0.02). The association of other GLM classes with the outcome was not significant.ConclusionDiabetes does not appear to modify the risk of SARS-CoV-2 infection in a clinically meaningful way, but strongly increases the rates of hospitalization and death. Insulin use was associated with worse outcomes, whereas metformin use was associated with lower mortality.

Patient Education| 2021 What is a Pediatric Dentist? Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation What is a Pediatric Dentist?. Pediatric Patient Education 2021; 10.1542/peo_document152 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Pediatric Specialist Handouts Topics: dentists Pediatric Dentists are dedicated to the oral health of children from infancy through the teen years. They have the experience and qualifications to care for a child's teeth, gums, and mouth throughout the various stages of childhood. Children begin to get their baby teeth during the first 6 months of life. By age 6 or 7 years, they start to lose their first set of teeth, which eventually are replaced by secondary, permanent teeth. Without proper dental care, children face possible oral decay and disease that can cause a lifetime of pain and complications. Today, early childhood dental caries—an infectious disease—is 5 times more common in children than asthma and 7 times more common than hay fever. Pediatric dentists have completed at least Four years of dental schoolTwo additional years of residency training in dentistry for infants, children, teens, and children... Copyright © 20042004American Academy of Pediatrics You do not currently have access to this content.

Early definitive airway protection and normoventilation are key principles in the treatment of severe traumatic brain injury. These are currently guided by end tidal CO2 as a proxy for PaCO2. We assessed whether the difference between end tidal CO2 and PaCO2 at hospital admission is associated with in-hospital mortality. We conducted a retrospective observational cohort study of consecutive patients with traumatic brain injury who were intubated and transported by Helicopter Emergency Medical Services to a Level 1 trauma center between January 2014 and December 2019. We assessed the association between the CO2 gap—defined as the difference between end tidal CO2 and PaCO2—and in-hospital mortality using multivariate logistic regression models. 105 patients were included in this study. The mean ± SD CO2 gap at admission was 1.64 ± 1.09 kPa and significantly greater in non-survivors than survivors (2.26 ± 1.30 kPa vs. 1.42 ± 0.92 kPa, p < .001). The correlation between EtCO2 and PaCO2 at admission was low (Pearson's r = .287). The mean CO2 gap after 24 h was only 0.64 ± 0.82 kPa, and no longer significantly different between non-survivors and survivors. The multivariate logistic regression model showed that the CO2 gap was independently associated with increased mortality in this cohort and associated with a 2.7-fold increased mortality for every 1 kPa increase in the CO2 gap (OR 2.692, 95% CI 1.293 to 5.646, p = .009). This study demonstrates that the difference between EtCO2 and PaCO2 is significantly associated with in-hospital mortality in patients with traumatic brain injury. EtCO2 was significantly lower than PaCO2, making it an unreliable proxy for PaCO2 when aiming for normocapnic ventilation. The CO2 gap can lead to iatrogenic hypoventilation when normocapnic ventilation is aimed and might thereby increase in-hospital mortality.

Neonates are the most frequently transfused population perioperatively. Current guidelines based on evidence from neonatal trials and expert consensus recommend restrictive transfusion strategies, with hemoglobin (Hb) transfusion threshold levels between 7.5 and 12.0 g/dL based on gestational age, postnatal age, oxygen dependency, respiratory support, hemodynamic status, and comorbidities. This retrospective observational single center study aimed to assess red blood cell (RBC) transfusion practices in neonates undergoing noncardiac surgery. The rate of RBC transfusion and incidence of over transfusion (Hb ≥12 g/dL) is reported. The relationship between postoperative Hb levels, perioperative RBC transfusion volume, and patient-centered outcomes is explored for transfused neonates. Following approval from the Boston Children's Hospital Institutional Review Board (IRB-P00029159), neonates undergoing noncardiac surgery who received a RBC transfusion in the perioperative period were included. Over transfusion was defined as an immediate postoperative Hb level ≥12.0 g/dL in transfused neonates. Patient demographics, laboratory variables, transfusion exposure, and clinical outcomes pertaining to the perioperative course were analyzed using univariate and multivariable logistic regression models. The primary aim was to define the rate of RBC transfusion in our total neonatal surgical cohort and to define the incidence of perioperative neonatal over transfusion for the transfused neonates. The secondary aims were to identify if patient or surgical factors correlate with the likelihood of perioperative over transfusion and determine if over transfusion and/or a transfusion volume threshold is associated with adverse postoperative outcomes, such as length of hospital or neonatal intensive care unit (NICU) stay, major morbidity, or mortality. The database spanned over a 6-year period from January 2017 to December 2023 and consisted of 1305 neonates who underwent noncardiac surgery at Boston Children's Hospital. In the total neonatal surgical population, the perioperative RBC transfusion rate was 22.8% (297/1305) and the 30-day mortality was 10.9% (30/274). Of those neonates transfused perioperatively, the incidence of over transfusion was 51.1% with 140/274 meeting the criteria for over transfusion (defined as Hb level ≥12.0 g/dL; median Hb 13.9, range: 12.0-21.3). Risk factors for over transfusion were preoperative Hb between 10 and 13 g/dL (odds ratio [OR] = 0.28 [95% confidence interval {CI}, 0.14-0.53]; P < .001) and preoperative Hb <10 g/dL (OR = 0.18 [95% CI, 0.07-0.44]; P < .001). No significant association (negative or positive) was found between over transfusion and postoperative outcomes, such as length of hospital (P = .151) or NICU stay (P = .549), composite morbidity (P = .868), 24-hour mortality (P = .051), 30-day mortality (P = .094), or 1-year mortality (P = .672). Neonates with 30-day postoperative mortality received significantly higher total transfusion volumes (median = 41.0 mL/kg [interquartile range {IQR}, 20.2-115.2]) than patients without 30-day mortality (median = 20.8 mL/kg [IQR, 14.8-34.0]; P < .001). Thirty-day mortality was increased (OR = 1.05 [95% CI, 1.01-1.09]; P = .027) per extra 5 mL/kg of RBCs transfused (after adjusting for age, weight, prematurity, preoperative anemia, emergency procedure, and American Society of Anesthesiologists physical status [ASA-PS]). Perioperative RBC transfusion volumes over a threshold of 25 mL/kg were significantly associated with increased 30-day mortality (median, 41.0 [IQR, 20.2-115.2] vs median, 20.7 [IQR, 14.8-34.0]; P < .001) and 1-year mortality (median, 26.3 [IQR, 19.6-62.5] vs 20 [IQR, 14.7-33.3]; P < .004). We report >22% of neonates were exposed to a RBC transfusion perioperatively in our entire surgical cohort with an incidence of >50% of those transfused being over transfused to Hb levels ≥12.0 g/dL. Our results suggest that transfusion volumes >25 mL/kg may be associated with worse outcomes. Our findings underscore the need for comprehensive evidence-based patient blood management strategies to clearly define acceptable perioperative conservative RBC transfusion thresholds and minimize unnecessary transfusions in neonates.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Hematologic Patients: Experience at the Hospital Attending More Patients in Spain

Various reasons for underperformance in physical sciences have been found, such as a lack of teachers’ content knowledge and a lack of resources. This study looks into the extent of alignment between the various levels of the curriculum on circuit electricity (intended, implemented and attained levels). The research took place in Mpumalanga amongst 1423 Grade 11 learners with their teachers at 42 South African schools. The study followed an exploratory research design, using an interpretive paradigm whereby the learners responded to a survey questionnaire, namely the learner electricity learning confirmatory questionnaire. Their teachers’ electricity teaching lesson plan was collected and analysed. The alignments of four different curriculum levels were compared, namely the formal curriculum (21 electricity topics in the Curriculum and Assessment Policy Statement); the perceived curriculum (the topics included in the lesson plans); the experiential curriculum (learner reports of topics studied); and the assessed curriculum (problematic electricity topics in diagnostic reports). This study provided evidence of a misalignment of the formal with the perceived, experiential and assessed curricula, but a closer alignment of experiential curriculum with the perceived and assessed curricula. Findings contradict the impression that teachers plan to teach for the examinations; however, they teach sections that do not appear in the exam. More alarmingly, teachers omit ‘conceptually difficult’ sections from their lesson plans but include the relevant applications of these concepts in calculations. District officials need to ensure that the difficult electricity concepts are taught, and they should make sure that the teachers teach what is expected in the formal curriculum.

In pediatric dentistry, self-assessment plays a pivotal role in students' professional development by enabling them to critically reflect on and evaluate their clinical competencies This study aimed to enhance clinical training in pediatric dentistry through structured student self-assessment, identification of educational gaps, and collaborative evaluation with educators to reinforce learning objectives and support continuous quality improvement. [cite: 50] Methods: A descriptive cross-sectional study was conducted over two weeks during the 2023/2024 academic year at Monastir Dental Clinic. [cite: 51] A total of 180 fifth-year Tunisian dental students completed a self-assessment questionnaire covering diagnostic confidence, clinical autonomy (5-point Likert scale), and overall preparedness/satisfaction (rated 1-10). [cite: 52] Gender data and open-ended feedback were also collected. Prior to deployment, the questionnaire was pretested for clarity and content validity. [cite: 53] Results: Of the 163 respondents (90% response rate; 73% female), diagnostic confidence varied: 22.1% for early childhood caries, 52.1% for malocclusion, and 40-50% for other conditions. [cite: 54] Autonomy in trauma management was reported by 67.5%, but only 4.9% felt fully autonomous in clinical protocols. [cite: 55] Preparedness averaged 6.3/10, and satisfaction was high (82.7% rated 5-8/10). [cite: 56] Data was analyzed using SPSS 22 and Excel 2020. Descriptive statistics were complemented by inferential analysis (Chi-square and Student's t-tests), revealing significant associations between satisfaction and both clinical preparedness (p < 0.001) and theoretical teaching adequacy (p = 0.001). [cite: 57] Female students reported significantly higher satisfaction (p < 0.001). [cite: 58] Conclusion: Students showed uneven diagnostic skills, especially with molar incisor hypomineralization (MIH) and early childhood caries (ECC.) Despite overall satisfaction, findings call for targeted pedagogical reforms to ease clinical transition and support skill development. [cite: 59].

The aim of this study was to study the knowledge and attitude of the pediatricians and family physicians on the dental counterpart, i.e. pediatric dentistry and the objective of this study were to determine what can improve the knowledge and attitude on pediatric dentistry and suggest certain methodologies to more participation of physicians in improving oral health. A systematic random survey of 400 pediatricians and 400 family physicians received a questionnaire pertaining to individual details, approach towards pediatric dentistry, knowledge level and the training on oral health received. Most of pediatricians and family physicians acknowledged the importance of pediatric dentistry. Less of pediatricians and more of family physicians predicted the parents may pose a barrier for referral. More number of pediatricians were aware of the oral benefits of breast feeding when compared to the family physician. Most of the practitioners in both groups were less aware of the first dental visit including ECC. Acknowledgement of the role in cleft lip and palate was more or less same in both groups of practitioners were as the effect of systemic disease on oral health was recognized by more number of pediatricians. Only a small percentage in both the groups acknowledged the cariogenicity of medicated syrups, which was substantiated by the fact that only a small number of physicians underwent dental training and most of them were accepting to undergo training. When basic medical training is provided in dental school, medical schools can also provide dental training. Dental lectures can also be incorporated into CME programs and recognition of pediatric dentistry by providing referral to needy patients have been suggested.