Educational Solutions for Workforce Development
Dentistry
The Design, Implementation & The Design, Implementation & Evaluation of Cultural Competence Evaluation of Cultural Competence Training & Assessment in Dental Training & Assessment in Dental Vocational Training in ScotlandVocational Training in Scotland
L E Prescott-Clements
Educational Solutions for Workforce Development
Dentistry
AimsAims
1. To develop & validate Cultural Competencies for Dentists in General Dental Practice.
2. To implement a programme of cultural competence training for Dental Vocational Trainees
3. To assess DVTs cultural competence using simulated patients within an OSCE format.
4. To evaluate the educational impact of the cultural competence training and assessment
Educational Solutions for Workforce Development
Dentistry
RACE
RELIGION
AGE
GENDER
DISABILITY
SEXUAL ORIENTATION
“OTHER”
Commn & Language
Courtesy & Respect
Avoiding Discrimination Clinical
Issues
Leadership & Management
Access Issues
Legislation
PRACTICAL SKILLS
ATTITUDES & BEHAVIOURS
KNOWLEDGE
Negative Assumptions
Training matrixTraining matrix
Educational Solutions for Workforce Development
Dentistry
`RACE RELIGION AGE GENDER DISABILITYSEXUAL
ORIENTATION
Not all individuals accessing dental care will speak English.Negative assumption that the individual does not speak English.Negative assumption that the individual is uneducated.Negative assumption that the individual will have poor dental health.Not all cultures attend regular check ups, rather only when there is a problem. Dentists should be pro-active in inviting regular attendance of such individuals.Some cultures ‘sharpen’ or remove teeth for cosmetic reason – dentists should investigate this sensitively.
Some religions fast at certain times.Women from some religions (Hindu, Muslim, Orthodox Jewish & some Sikh women) may wish to be treated by an individual of the same sex, or to have a chaperone.Religious Holidays
Negative assumption that older peoples’ opinions are less important and the practitioner ‘knows best’.Negative assumption that physical or communication problems are associated with mental difficulties.
Negative assumptions around single mothers’ financial security.
A wide range of disabilities exist, there is no fixed list. Areas include difficulties with MOBILITY, SIGHT, HEARING (or both), LEARNING DIFFICULTIES, and COMMUNICATION DIFFICULTIES. Wide range of information available on Fair for All website for all these groups.Negative assumption that physical or communication problems are associated with mental difficulties
LGBT individuals may be reluctant to disclose their sexual orientation, or any info (e.g. medication) that may reveal this.
Theme - AssumptionsTheme - Assumptions
Educational Solutions for Workforce Development
DentistryTraining formatTraining format
Half day introduction
Week 1
Learning outcomes
Didactic
Training Day
8 workshops
20 minutes
small groups (4 x ~ 20 trainees),
Educational Solutions for Workforce Development
Dentistry
Stakeholder WorkshopsStakeholder Workshops
The Good Life Group
(Learning Disabilities)
Scottish Transgender
AllianceScottish Interfaith Council
Scottish Disability Equality Forum Ethnic
Minority / refugee
experiences
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Dentistry
Role-play WorkshopsRole-play Workshops
Elderly Deaf patient
attends with carer
Employment Law scenario
(Racial Discrimination)
Inappropriate racial
remarks from a patient
Educational Solutions for Workforce Development
Dentistry
AssessmentAssessment
Implemented during month 8/9
North and West trainees
OSCE comprising 4 simulated patient cases
Trainee given short brief
Detailed scoring rubrics for assessment with performance indicators
Clinical and non-clinical assessors
Educational Solutions for Workforce Development
Dentistry
ScenariosScenarios
•
Patient (wheelchair user) attends 6 months following a major stroke. She has difficulty with speech and attends with her carer.
Inappropriate remarks made by the dental nurse in front of a gay patient, who is extremely offended.
Patient with mild Aspergers Syndrome attends for a check up.
Patient from the Church of the Latter Day Saints faith attends for a filling, but cannot have routine anaesthesia due to adrenalin component.
Educational Solutions for Workforce Development
Dentistry
Sexual Orientation ScenarioSexual Orientation Scenario
Dentist has completed the examination and re-enters the room.
Patient chats with dentist.
Dental nurse enters the room and chats with patient
Dental nurse makes offensive remarks
Series of opportunities for dentist to intervene.
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Dentistry
Scenario ResponseScenario Response
Lack of control of the situation
Slow response
Unaware of comments – attention or implications
Avoiding the issue
Chaperone issue
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Dentistry
Impact EvaluationImpact Evaluation
Reaction
Learning
Performance
Outcome
Educational Solutions for Workforce Development
Dentistry
Impact EvaluationReaction
Questionnaire to complete after each workshop
• How much do you feel you have learned?
• How useful was the information?
• How stimulating was the workshop?
• Please rate the discussions?
• How good a use of time?
• Would you change practice as a result?
Educational Solutions for Workforce Development
Dentistry
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6
Good LifeGroup
ScottishTransgender
Alliance
ScottishInterfaithCouncil
Role Play[ElderlyPatient]
InnocentJakisa
ScottishDisability
Forum
Role Play[Dental
Nurse]
Role Play[Inappropriate
Remarks]
How much do you feel you learned?
Nothing
A lot
Educational Solutions for Workforce Development
Dentistry
0
10
20
30
40
50
60
The Good LifeGroup
ScottishDisabilityForum
ScottishTransgender
Alliance
InnocentJakisa
ScottishInterfaithCouncil
Role Play -Dental Nurse
Role Play -Inappropriate
Remarks
Role Play -Elderly patient
Workshop
Yes
No
Will you change practice as a Will you change practice as a result?result?
Educational Solutions for Workforce Development
DentistryHow will you change practice?How will you change practice?
“Ask patients more about their individual needs”
“Try to be less judgemental when it comes to any form of disability”
“Ensure to take more time in understanding and not talking down to people”
“Keep language simple but not patronising”
Good Life Group
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Dentistry
How will you change practice?How will you change practice?
“More supportive of transgender people as I now understand better the issues they face with themselves”
“Pass on the information to colleagues so that everyone knows the legal implications of disclosing gender history”
“Be more open with pts and not be afraid to ask how they would like to be treated/ addressed.
Scottish Transgender Alliance
Educational Solutions for Workforce Development
Dentistry
Impact Evaluation Impact Evaluation Learning and PerformanceLearning and Performance
•
•Training was given to West region trainees only
•Both the North region trainees [control group] and the West region trainees were assessed.
•Compared assessment performance
Educational Solutions for Workforce Development
Dentistry
EvaluationEvaluation
•
Attribution?
Patient Assessment Questionnaires
GDC cases
Complaints
MDDUS
Outcomes
Educational Solutions for Workforce Development
DentistryRefinementsRefinements
•
No induction module
Training
Longer sessions
Smaller groups
More discussions, legislation and examples
New scenario
Assessment
Refine and add scenarios
Debrief