Co-designing an effective undergraduate course for the appropriate management of medical emergencies in dental practice

Introduction/background: There is an expectation within the community and from professional bodies, that dentists will have the capacity to manage common adverse reactions and medical emergencies that may occur in a dental setting. The Australian Dental Council (2016) defines the specific and supporting threshold competencies expected of all Australian dental graduates including the ability to manage both dental and medical emergencies. However, it is widely recognized that without appropriate teaching methods, a significant proportion of dental graduates both locally and internationally feel poorly equipped to manage a medical emergency. Dentists are required to perform invasive and occasionally extensive oral procedures in a community-based setting on a diverse clientele. An ageing population coupled with advances in medical management and an increased burden of chronic disease means that clients may on occasion have significant co-morbidities or risk factors. Consequently, dental practitioners in Northern Australia report frequently encountering medical events in their daily practice. The emphasis on emergency management in a dental setting in Australia is currently on recognizing, pre-empting and treating clinical deterioration before it escalates to an emergency situation (Oral & Dental Expert Group, 2012) The JCU Bachelor of Dental Surgery prepares work-ready graduates for practice in regional, rural and remote areas. Students are required to be competent managing both dental and medical emergencies in clinical and community settings. Through co-design with dentists and simulation-qualified emergency educators, an authentic, scenario-based training course has been developed in accordance with current guidelines. This effectively enables dental students to respond appropriately to medical emergencies in the dental clinic. Aim: The aim of this presentation is to share the lessons learnt through five years of co-designing, delivering and assessing medical emergency competency for the JCU Bachelor of Dental Surgery students. Methods: Post-workshop questionnaires and qualitative data from debriefing staff and students have informed the current training methodology. Through applying an iterative, participatory action approach to the medical emergency training has enabled the co-design of a high fidelity, simulation program that embeds authentic scenarios into the clinical setting. The objective has been to consolidate students’ existing theoretical knowledge while providing practical skills and strategies that enhance teamwork, communication, confidence as well as competence. Discussion: Following ongoing review and evaluation, the use of high fidelity simulated patients and authentic scenarios have been found to be the most effective strategy for enabling undergraduate dentistry students to respond competently and confidently to patients who are medically compromised. The results support the transition from manikins to authentic scenarios within the clinical setting enacted by emergency educators skilled in simulation followed by comprehensive debriefing. This has equipped senior students with adequate theoretical and practical knowledge to feel prepared for appropriately managing common emergency situations independently or with minimal assistance when practising in diverse regional, rural and remote contexts

Socially accountable selection of dental students for regional and remote Australia

The mission of the James Cook University (JCU) Dental Surgery program is to educate dentists to meet the oral health needs of Northern Australia with an emphasis on rural, remote, Indigenous and tropical health. This presentation will describe the socially accountable selection processes adopted by JCU so as to enable participation by a broad range of students, including those from under-represented populations as part of the widening participation agenda. JCU Dentistry currently has triple the number of Indigenous students than other Australian programs, some of whom enter through an enabling pathway program. Socially accountable practices that move beyond an emphasis on academic excellence create a tension as people with lower chances of academic "success" may be selected. This challenge is being met by embedding capacity building and support practices into the pre-clinical curriculum so these students can attain the required standards and achieve success. The first graduation will be in December 2013. To maintain this socially accountable approach, selection processes must explicitly manage the tension between expectations of academic excellence and inclusive practices

Enabling successful transition to rural practice through curriculum design and practices

Background: The Bachelor of Dental Surgery (BDS) at James Cook University was established in 2009 with the mission to address the population health needs and workforce shortages of rural, remote and tropical Australia. This presentation will focus on how aligning curriculum design and clinical experiences enables and encourages transition to graduate careers in rural, remote and regional areas. Methods: Through an iterative process, data gathered from student feedback surveys since 2010 has informed curriculum development and innovative program design, which is reviewed annually. A capstone program is currently being evaluated. Results: Student feedback and annual review has informed changes to how the rural and remote focus is embedded into curriculum across the pre-clinical and clinical years of the BDS. The establishment of a final capstone year is effectively enabling alignment of the Australian Dental Council's Professional attributes and competencies of the newly graduated dentist with the distinctive profile of a rural dental practitioner. Conclusion/Recommendations: Ongoing student feedback will inform program design and delivery to optimise engagement with learning opportunities and clinical experiences. Further research is required to evaluate whether the current curriculum design can continue to reliably enable transition to the rural workforce given the emerging funding challenges

Exploring the impact of James Cook University BDS graduate intentions and destinations on the rural and remote dental workforce

Background: The Bachelor of Dental Surgery (BDS) at James Cook University was established in 2009 with the mission to address the population health needs and workforce shortages of rural, remote and tropical Australia through aligning student selection, curriculum and clinical experiences to enable and encourage graduate careers in rural, remote and regional areas. This paper reports early evidence on the career outcomes of graduates in the first three cohorts. Methods: Data were gathered from two sources to allow mapping of career intentions and graduate destinations. An exit survey provided student data followed by tracking graduate careers of 2013 to 2015 cohorts. Results: A significant proportion of JCU dental students intended to practise outside capital cities. Many graduates planned to work initially in rural towns or outer regional centres with progression to practice in larger centres. Conclusion/Recommendations: While ongoing follow up will track career progression over a longer time, the data so far suggest that the career outcomes of JCU dental graduates are aligned with the workforce needs of the region. Further research is required to compare data with intentions and destinations of from those graduating from Australia's predominantly metropolitan dental schools. This next stage will reveal whether program design is an reliable predictor of graduate careers and will inform ongoing initiatives to build the regional, rural and remote dental workforce

Enabling successful transition of dental graduates to regional and remote practice through curriculum design and clinical practice

The Bachelor of Dental Surgery (BDS) at James Cook University (JCU) was established in 2009 as a socially accountable program with the mission to address the population health needs and workforce shortages of rural, remote and tropical Australia. This presentation will focus on how aligning curriculum design and clinical experiences enables and encourages transition to graduate careers in rural, remote and regional areas. An ongoing process of evaluation involving data gathered from participatory action research, student feedback surveys, clinical partners, and graduates has informed development of the innovative curriculum design of the JCU program. The rural and remote focus is embedded into the dental curriculum across the pre-clinical and clinical years. In addition to clinical and cultural competency, the course prepares dental graduates for interdisciplinary teamwork in rural and remote practice. This pioneering dental program also embeds education on domestic violence (DV-RRR) and authentic medical emergency simulations. Final year students complete extended clinical placements in rural and remote communities; this is essential if graduates are to feel comfortable and competent to join the remote health workforce. Ongoing feedback is informing program design and delivery to optimise engagement and preparedness for practice. With student input, learning opportunities and clinical experiences can prepare ‘fit for purpose’ graduates whose distinctive profile and capabilities enable them for transition to the rural and remote workforce. Destination data and GIS mapping of graduate destinations reveals the significant contribution JCU dental graduates have made to the rural and remote oral health workforce since 2013. However, given the given the challenge of funding rural and remote student placements, further research is required to evaluate the impact of the current policy and budgetary environment on the viability of the current curriculum. This may reduce the capacity to continue contributing work-ready graduates to the future rural health workforce

Transitioning 'fit-for-purpose' dental graduates into regional and remote practice through curriculum design and clinical placements

Background: The Bachelor of Dental Surgery (BDS) at James Cook University (JCU) is a socially accountable program designed to address the population health needs and workforce shortages of rural, remote and tropical Australia. This presentation will focus on how aligning curriculum design and clinical experiences enables successful transition to graduate careers in remote and regional areas. Methods: An ongoing cycle of review involving evaluation data gathered from students, graduates and clinical partners has informed development of the innovative curriculum design of the BDS. This pioneering dental program embeds the rural and remote focus and assures clinical competency involves responding appropriately to domestic violence and medical emergencies. Final year students complete extended clinical placements in rural and remote communities; this is essential if graduates are to feel comfortable and competent to join the remote health workforce. Outcomes: Ongoing feedback is informing program design and delivery to optimise engagement and preparedness for practice. With student input, learning opportunities and clinical experiences can prepare "fit for purpose" graduates whose distinctive profile and capabilities enable them for transition to the rural and remote workforce. Graduate destination data reveals the significant contribution JCU dental graduates have made to the rural and remote oral health workforce since 2013. However, given the challenge of funding remote student placements, further research is required to evaluate the impact of the current policy and budgetary environment on the viability of the curriculum. This may reduce the capacity to continue contributing work-ready graduates to the future rural and remote health workforce

Exploring the impact of James Cook University BDS graduate intentions and destinations on the rural and remote dental workforce

Background: The Bachelor of Dental Surgery (BDS) at James Cook University was established in 2009 with the mission to address the population health needs and workforce shortages of rural, remote and tropical Australia through aligning student selection, curriculum and clinical experiences to enable and encourage graduate careers in rural, remote and regional areas. This paper reports early evidence on the career outcomes of graduates in the first three cohorts. Methods: Data were gathered from two sources to allow mapping of career intentions and graduate destinations. An exit survey provided student data followed by tracking graduate careers of 2013 to 2015 cohorts. Results: A significant proportion of JCU dental students intended to practise outside capital cities. Many graduates planned to work initially in rural towns or outer regional centres with progression to practice in larger centres. Conclusion/Recommendations: While ongoing follow up will track career progression over a longer time, the data so far suggest that the career outcomes of JCU dental graduates are aligned with the workforce needs of the region. Further research is required to compare data with intentions and destinations of from those graduating from Australia's predominantly metropolitan dental schools. This next stage will reveal whether program design is an reliable predictor of graduate careers and will inform ongoing initiatives to build the regional, rural and remote dental workforce

Growing a dental workforce for regional and remote Australia: tracking the paths of James Cook University's first graduates

Background: The purpose and vision of the regional dental school at James Cook University (JCU) was presented at the 2010 "Are you remotely interested?" conference. Preliminary data on the preferred destinations and current practice location of the first graduate cohort. Aims of Study: To identify the main reason JCU Bachelor of Dental Surgery graduates chose their first practice location and subsequent relocation if applicable. Method: Design and participants: This study invited the first 54 graduates from the JCU Bachelor of Dental Surgery to participate in a survey on completion of their degree. Follow-up through an email survey and phone contact provides additional recent data. Main outcome measures: Graduates' main reason for choosing their graduate location and subsequent relocation in their first practice year (2014). Their current place of practice will be compared with their preferred employment location on completion of the BDS. Any post-graduate training undertaken during the graduate year will also be captured. Results: Respondents to initial survey (n = 54; response rate = 100%) reported both personal factors and professional opportunities as the primary drivers for choice of employer and location. The follow-up survey is currently in progress and preliminary findings will be available in August. Conclusion: JCU is making a significant difference to the regional and remote dental workforce

Growing a dental workforce for regional and remote Australia: tracking the paths of James Cook University's first graduates

Background: The purpose and vision of the regional dental school at James Cook University (JCU) was presented at the 2010 "Are you remotely interested?" conference. Preliminary data on the preferred destinations and current practice location of the first graduate cohort. Aims of Study: To identify the main reason JCU Bachelor of Dental Surgery graduates chose their first practice location and subsequent relocation if applicable. Method: Design and participants: This study invited the first 54 graduates from the JCU Bachelor of Dental Surgery to participate in a survey on completion of their degree. Follow-up through an email survey and phone contact provides additional recent data. Main outcome measures: Graduates' main reason for choosing their graduate location and subsequent relocation in their first practice year (2014). Their current place of practice will be compared with their preferred employment location on completion of the BDS. Any post-graduate training undertaken during the graduate year will also be captured. Results: Respondents to initial survey (n = 54; response rate = 100%) reported both personal factors and professional opportunities as the primary drivers for choice of employer and location. The follow-up survey is currently in progress and preliminary findings will be available in August. Conclusion: JCU is making a significant difference to the regional and remote dental workforce

Teaching health promotion competencies in undergraduate dentistry training: A unique pedagogical approach

Issue Addressed: Using appropriate pedagogical approaches in undergraduate dentistry training is important to develop student's health promotion knowledge, and to shape their attitude towards using these competencies in future dentistry practice. This brief report documents the signature pedagogical approach developed for an undergraduate health science subject at James Cook University, to teach dentistry students health promotion competencies. Pedagogical Approach: The signature pedagogy involves three key approaches – experiential learning, cooperative learning and inquiry-based learning. Experiential learning “beyond the classroom” enables students to develop and deliver a school-based oral health promotion program. “Inside the classroom,” role-plays encourage students to apply their health promotion skills to real-world dentistry scenarios. Cooperative learning techniques such as “think, pair, share” create a supportive environment for students to confidently exchange ideas; and inquiry-based learning engages students in thinking critically about health promotion strategies to address contemporary oral health challenges. These pedagogical approaches have developed student's understanding of the health promotion competencies required of a newly qualified dentist. Conclusion: Pedagogical approaches that engage dentistry students in experiential, cooperative and inquiry-based learning are important considerations for undergraduate teaching, to strengthen understanding of health promotion and to help shape student's attitude towards using these competencies in future dentistry practice