Andrea Pinnick Final Assignment

Title:  Introduction to Communication Skills in Pediatric Dentistry

 

Competency:  Patient Care, Interpersonal and Communication Skills

 

Learners:  1^st Year Pediatric Dental Residents

• ·         Course will be given during the residency orientation/summer trimester
• ·         July:  4 week course
• ·         August:  1^st week:  Learner Assessment

 

Background:  Effective communication skills are essential for successful treatment of the pediatric dental patient.  Pediatric dentistry requires flexibility in patient management.  In the world of dealing with children, one must always be prepared to improvise as the situation requires.  It is important to be competent with all behavior guidance techniques (basic and advanced), as each patient encounter may require multiple strategies and each visit is unique with different demands.  Behavior guidance is a continuum of interaction involving the dentist and dental team, the patient, and the parent, directed toward communication and education. ¹ Behavior guidance requires skills in communication, empathy, flexibility, coaching, and active listening.  Decisions regarding use of behavior guidance technique must include obtaining informed consent and proper chart documentation.  Informed consent should be explained in terms that the parent can understand and accept to play an active role in the decision making process.  Successful completion of diagnosis and therapeutic services should be viewed as a partnership of dentist, parent, and child.² Effective communication skills are important to increase both patient and dentist satisfaction and reduced malpractice actions.  Competency in effective communication is also a vital component of achieving health literacy for patients, which is needed for improved health outcomes.  The American Dental Education Association recommends that dental schools include communication skills training.³

 

Course Goals:  The goals of the skills-based behavior guidance course are to build effective communication skills, to help alleviate patient fear and anxiety and build trusting relationships with the pediatric dental patient that will ultimately allow pediatric dentists to deliver quality dental care and promote in the child a positive attitude towards dental care and oral health.

 

Objectives:  At the end of the course, learners should be able to:

1. Define the goals of communication in pediatric dentistry
2. Describe and perform written communication skills
3. Describe and perform skills of basic behavior guidance
4. Describe skills of advanced behavior guidance
5. Obtain informed consent for behavior guidance techniques

 

Course Content/Topics:

Pre-Assignment Class Readings:

• Readings: 
• Nash, David A.  Engaging Children’s Cooperation in the Dental Environment through Effective Communication. 
• AAPD.  Guideline on Behavior Guidance of the Pediatric Dental Patient. 
• Assignment: 
• 1-2 page written reflection on experiences with behavior guidance/communication skills in pre-doctoral pediatric dentistry clinical experiences, identified strengths and weaknesses, and what the student hopes to gain (knowledge/skills) during their pediatric residency program in regards to communication skills and patient management.   

Week 1:  Communication Skills (2 hours--3 days per week)

•  Introduction to Pediatric Dentistry
• Pre-Test OSCE (Knowledge, Skills, Attitude:  Communication Skills/Behavior Guidance)
• Improv:  Ice Breaker
•  Patient Assessment:  Child Cognitive Development & Euphemistic Language
•  Communication Skills:  Non-verbal Communication, Active listening, Self-Disclosing assertiveness, Descriptive Praise, Requests and Promises
•  Obtaining Medical & Dental History
•  Chart Documentation:  EHR

Week 2:  Basic Behavior Guidance Techniques (2 hours didactic/small group--3 days per week; 2 six-hour clinic sessions)

• Basic Behavior Guidance Techniques:  Positive Reinforcement, Distraction, Tell-Show-Do, Voice Control, Behavior Shaping
•  Direct Patient Care

Week 3:  Advanced Behavior Guidance Techniques (2 hours didactic/small group--3 days per week, 2 six-hour clinic sessions)

• Advanced Behavior Guidance Techniques:  Protective Stabilization, Sedation, General Anesthesia
•  Obtaining informed consent for Advanced Behavior Guidance Techniques:  Role-Play Exercise; standardized patient (parent)
• Chart Audit:  Self-assessment/peer-assessment with itemized checklist
• Direct Patient Care

Week 4:  Application of Techniques/Practical Considerations (2 hours didactic/small group--3 days per week, 2 six-hour clinic sessions)

• Practical Considerations:  Scheduling, Parental influence, Child-Parent Separation, Reinforcements, Dental Attire and office environment “child-friendly”, Patient Diversity/Cultural Competence, Presence of communication deficits of the patient (eg, hearing disorder)
• Standardized videos of clinical scenarios with small group discussion; think-pair-share on best techniques to use
• Review of self and peer videotapes of clinical encounters using basic behavior techniques, communication skills (interviewing):  Self-assessment/peer-assessment with itemized checklist
• Direct Patient Care

Week 5:  Post-Test OSCE/Commitment to Act

 

Teaching Strategies:

• ·         Didactic Instruction:  Lecture and videos of behavior guidance techniques, communication skills, and interviewing techniques
• ·         Role-Playing
• ·         Standardized patient (parent)
• ·         Small Group Discussions--Think, Pair, Share
• ·         Direct Patient Care
• ·         Reflection on Videotaped clinical encounters
• ·         Electronic Health Record Chart Audit

 

Learner Assessment:

1)      Pre-Test/Post-Test OSCE

2)      Electronic Health Record Chart Audit

3)      Direct Observation of Faculty and Chairside Dental Assistants:  Itemized Checklists/Rating Scale

                    Multisource feedback

4)      Student Evaluation/Feedback to be given both written and verbal by course director

 

Course Evaluation:

1)      Pre-Test/Post-Test OSCE

2)      Course Evaluation completed by students 

3)      OSCE to be evaluated after 1^st year of residency and completion of 2^nd year prior to completion of training program

 

References:

1. Competencies for the new dentist.  J Dent Educ 2006; 70(7): 757-9.
2. Feigal RJ.  Guiding and managing the child dental patient:  A fresh look at old pedagogy.  J Dent Educ 2001; 65(12):1369-77.
3. AAPD Policies and Guidelines. Guideline on Behavior Guidance for the Pediatric Dental Patient. http://www.aapd.org/media/Policies_Guidelines/G_BehavGuide.pdf
4. Cannick, G.F., Horowitz, A.M., Garr, D.R., Reed, S.G., Neville, B.W., Day, T.A., Woolson, R.F., Lackland, D.T.  Use of the OSCE to Evaluate Brief Communication Skills Training for Dental Students.  J Dent Educ 2007; 71(9), 1203-9. 
5. Casamassimo, et al.  The Future of Pediatric Dentistry Advanced Ecuation:  The Need for Change in Training Standards.  Pediatr Dent 2009; 31(4):  298-309.
6. Kalwitzki, Matthias, Meller, Christina, Beyer, Christine.  Does Teaching Method Affect Students’ Perceptions Regarding Communication Patterns in Pediatric Dentistry?  A Comparison of Lecture and Video Methods.  J Dent Educ 2011; 75(8), 1084-1091.
7. Nash, David.  Engaging Children’s Cooperation in the Dental Environment through Effective Communication.  Pediatr Dent 2006; 28:455-9. 

 

Comment from Michelle Rickard

As always, your presentation is very well organized with an excellent progression in learning for the student.  Your presentation documents each step from gaining basic knowledge on interpersonal communication skills as they relate to the pediatric patient and their parents through practicing more advanced skills.  The learning activities support the objectives you stated for the curriculum.  And you have thought out effective measurements for both learners and the curriculum.  In particular, you provide multiple methods with multiple evaluators for the students.  I don't know if this is a requirement in dentistry but it is a requirement in ACGME competency-based education.  For the curriculum evaluation, I like that you have included continued follow up beyond the intial evaluation at the end of the four week course.  It seems to be an ambitious curriculum but very well structured.

The one element that I wondered about, especially with the first session, is how involved is the learner in the instruction?  With the first session, it seems to be primarly lecture on basic communication skills.  Are there learning tools you could use to make the lectures more interactive?  Of course, in the other modules you do have learner-centered exercises where there is videotaping and small group discussion.  Perhaps this balances out the more lecture-based first session.