Preclinical Patient Case Scenarios as an Aid to Clinic Preparation

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1 Preclinical Patient Case Scenarios as an Aid to Clinic Preparation Gary L Drahos DDS Jay R Geaman DDS Kevin Van Kanegan DDS Midwestern University College of Dental Medicine- Illinois

2 Learning Objectives for This Presentation Describe a method of integrating oral health care disciplines using patient care scenarios Describe the resources needed to develop and deliver curriculum using patient care scenarios Describe methods to assess student progress and readiness to treat patients in the dental clinic using patient care scenarios Identify probable outcomes of curricula integrating oral health care disciplines using patient care scenarios

3 How Does The Brain Work? How Do People Learn And What Is The Most Effective Way To Teach?

Institute of Technology The Brain Research through

4 Computers Decoding Our Brains 10 Year Project To Decode All Brain Activity The Human Brain Project- Swiss Federal Institute of Technology The Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative- U.S. HHS

5 brain rules 2013 ADEA Convention

6 Begin With The End In Mind John Medina ( ADEA 2013-Seattle) Our End Is To Prepare The Students To Provide Competent, Ethical Patient Care of the Highest Quality and Aid With Their Transition to the Patient Care Clinic

7 Midwestern University College of Dental Medicine- Illinois Integrated Preclinical Curriculum Oral Health (Dental) Sciences Diagnostic Treatment Risk Assessment, Planning Comprehensive and and Diagnosis Rehabilitative Initial and Therapeutic Oral Preventive Health Care Interventions Care Dentistry of Oral Diseases versus oral diagnosis, periodontics, operative dentistry, prosthodontics, orthodontics, etc. taught independently. Risk Assessment, Diagnosis and Preventive Care of Oral Dieases Grounded in clinical cases & scenarios Plenary and small groups Experiential, community involvement Clinical Simulation -Contextualize learning in clinical cases as much as possible

8 CDMI Has A Beautiful Patient Care Facility Midwestern University College of Dental Medicine Illinois Dental Institute Downers Grove, IL

9 But As Luck Would Have It DENT 1650 (Oral Health Sciences) - 5 Full Days Per Week

10 Our Goal Was Simple: Create Real Life Patient Care Experiences On Manikins A Day in the Clinic

clinic sessions for organizational and time management Makes the course interesting and

11 Why? Fulfills the objectives of our integrated curriculum Contextualizes learning concepts in preparation for patient care Provides a realistic insight into actual clinic sessions for organizational and time management Makes the course interesting and stimulating for the students and faculty P.T. Barnum and Steve Jobs- Give the people what they want

12 How? Create unique case scenarios that present various common clinical situations requiring multiple areas of decision making and demonstration of diagnostic abilities and dental treatment 17 patient scenarios were developed that had electronic health record (AxiUm), printed patient information and live patient interaction components.

3 ½ hours Kavo DSE plus units Each student has their own EHR portfolio of

13 131 students 16 groups of 8 Our Physical Set-Up 42 partime faculty ( ratio of 8 students per faculty member) 10 week quarter based Simulated Clinic Sessions are 3 ½ hours Kavo DSE plus units Each student has their own EHR portfolio of patients Groups of 8 students- all received different patient scenarios for each session

14 The Case Set-Up 11 case scenarios for use during the course 6 case scenarios for the final exam sessions Electronic patient component for each patient Written posted scenario for each patient Photos and radiographs Assignment for cases posted 1 week in advance All students complete all 17 cases Grading is Satisfactory/Unsatisfactory No remediation Each case is valued at 1% of the students final grade

for self assessment Organize work station Procure devices to demonstrate

15 Our Student Set-Up Cases posted at the beginning of the quarter and occasionally modified througout the quarter Students assemble criteria sheets for self assessment Organize work station Procure devices to demonstrate collection of diagnostic information Prepare to interview patient and answer patient queries

16 Goals for The A Day in the Clinic Sessions the END Demonstrate skills that will enable the student to seemlessly transition to the clinical environment prepared to treat patients Allow students to integrate the skills necessary to collect patient data, evaluate oral health, diagnose disease, treatment plan and provide treatment for simulated patients Demonstrate appropriate data collection techniques Develop a comprehensive treatment plan Demonstrate ethical and professional behavior in interactions with patients and colleagues. Develop appropriate differential diagnoses Understand the interdisciplinary and interprofessional approach to oral care Evaluate their dental skills using prepared criteria sheets Develop Organizational skills

17 Some Examples of the Case Scenarios AxiUm element Scenario elements Photos Radiographs

18 Session Assignment ( Other Things Going on in the course)

19 4 Handed-BP-MOD Amalgam

Checklist for Successful Completion Date:1/24/2014 Checklist for Guided Study C Case A /Students: Oliver Canada Proper Case Presentation #18 MOD prep criteria form #18

21 Checklist for Successful Completion Date:1/24/2014 Checklist for Guided Study C Case A /Students: Oliver Canada Proper Case Presentation #18 MOD prep criteria form #18 MOD restoration criteria form Dental Assistant Criteria Form Blood Pressure Criteria form Enter patient's BP into EHR Daily tx Note Faculty Evaluation Student Self Assessment

22 Prosthodontic Case- Rx-EHR Case B- Prosthodon

23 Axium

24 Checklist for Successful Completion Case B/ Student: Nolan Ryan Proper Case Presentation #18-#20 prep crit form Date:1/24/2014 Checklist for Guided Study Cases(all criteria froms must contain self assess.) Case A /Students: Oliver Canada #18-#20 provisional crit form Enter patients BP today Change Medication to metoprolol in EHR Proper Case Presentation #18 MOD prep criteria form #18 MOD restoration criteria form Dental Assistant Criteria Form Blood Pressure Criteria form Enter patient's BP into EHR Daily tx Note Daily Tx Note Prescription for Tylenol or NSAIDs Case C/ Student: Faculty Evaluation Student Self Assessment

25 Pediatric Case Pediatric Parent Interview-Radiograph

27 Faculty Evaluation Student Self Assessment

28 Anterior Caries Removal- Ant. Restoration-EHR-BP Anterior Caries Removal

For the Early Birds Scenarios in Ethical Decision Making and Professionalism Swallowing indirect restorations Patient injury by equipment Insurance

31 For the Early Birds Scenarios in Ethical Decision Making and Professionalism Swallowing indirect restorations Patient injury by equipment Insurance payment dilemmas Use of new dental contraptions Skipping parts of treatment plans for profit Billing issues Diagnosis issues Employee problems Charity work

32 Urgent Care Urgent Care-Post restorations- Endo access-rx- EHR

36 RPD MD Consultation-BG

39 Other Patient Scenarios Smooth Surface Restorative-Material Selection- OP- Tx Plan Articulator Exercise Wax Caries (ICDAS)- EHR Cavity Preparation Design Material Selection-Liners Comprehensive Examination Patient Restorative Material Selection - Bisphosphonates Rest. Material selection-op-rx- AB Premed

40 Cases Included BP BG Plan for post op pain control Provide a written consultation Patient interview Material selection decisions Critical thinking decisions Treatment note Prescriptions Evidence based research Communication skills Legal and regulatory concepts Practice management Collaboration with other members of the health care team Ethics and professionalism Premedication

41 Funny Thing Happened Everybody was Finishing Early Students Got Very Proficient At Finishing The Cases For The Final Exam Cases We Increased The Level Of Complexity Of The Cases

42 4 Handed-material selection-impression-rx

43 Axium

44 Defend Dental Material Selection

45 Checklist

46 Complex restoration-op-rx-premed

48 Checklist

49 Pediatric- strip crowns-heart valve- Rx-Radiol

50 Axium montana

52 Urgent Care-Anterior restorations- Endo access-rx-op- EHR

56 Other Patient Scenarios PFM crown and Provisional-OP-Consultation form- Rx-Scaling Anterior Teeth Smooth Surface Rest.-Mater. Selection- OP- Tx Plan Smooth Surface- OP (malignancy)-consultation form-rx

57 brain rules 2013 ADEA Convention

59 Challenges with These Types of Sessions Constructing Cases That Can Be Accomplished In The Time Constraint Of The Sessions Good Assessment of Learners Different Students Performing Different Patient Care Faculty Calibration Development time Student Scheduling

60 Areas not covered by these scenarios Long Term Patient Care Outcomes Unforeseen Difficulties Anesthesia and Pain Control Moving Patients Patient scheduling and appointment management Esthetic concerns Billing and collections

61 What these scenarios do allow is Formative and Summative Assessment of: Problem Solving Clinical Reasoning Procedural Products Professionalism Ethical Decision Making Communication Skills Plus: Time management Four Handed Dentistry Organizational Skills Application and assessment of learning in a higher fidelity, discipline integrated, patient contextualized setting with the student increasingly taking the role of decision maker.

62 Outcomes Student Evaluations and Grades Student Course Evaluation 4.65/5.00 n = 80 Faculty evaluation A Day in the Clinic evaluation 4.9/5.00 n=40 Students successfully completed 8/11 Cases (only 10 counted) It took some students several cases to adapt to the this type of learning and assessment Virtually no pushback on grades assigned

63 Student Narrative Comments

64 Student Narrative Comments

65 Student Narrative Comments

66 Student Narrative Comments

67 Not All Positive Comments

68 Challenges and Considerations Development time and effort -scenarios -rotation schedules Resource demands Faculty calibration needs Coordination of sessions-lot of students going in a lot of different directions Need a single person at each session to be the final arbiter of assessment decisions

69 Benefits we have observed This type of curriculum can be implemented at any point in the students preclinical program if tailored to students current level of understanding and skill. By embedding learning in real life context it becomes relevant and important to learners. As curriculum progresses cases become increasingly complex and expectations of learners increase accordingly. Increasing expectations of self-direction and defensible decision making. Provides safe practice that learners perceive as good preparation for clinical care. Affords opportunities for comprehensive assessment of knowledge, skills and behaviors.

70 SuQuestMents Suggestions Questions Comments

The University of Florida College of Dentistry in compliance with Standard 2-9.

The University of Florida College of Dentistry in compliance with Standard 2-9. Critical Thinking 2-9 Graduates must be competent in the use of critical thinking and problemsolving, including their use in the comprehensive care of patients, scientific inquiry and research methodology.