Oral Health Knowledge, Attitudes, and Learned Clinical Skills in Pediatric Medicine Residents and Nurse Practitioner Students: A Pre-Post Design
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Setting
2.2. Sample Selection
2.3. CARE-PD Program/Oral Health Curriculum
2.4. Survey Development and Administration
2.5. End of Program Focus Groups
2.6. Statistical Analysis
3. Results
3.1. Survey Completion and Sample Characteristics
3.2. Survey Response
3.3. Qualitative Responses
4. Discussion
4.1. Limitations
4.2. Implications for Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Curriculum | Pediatric Medicine | PNP Students—1st Year | FNP Students—1st Year | Evaluation | ||||
---|---|---|---|---|---|---|---|---|
Academic Quarters | Winter—8 Weeks | Fall | Winter | Spring | Fall | Winter | Spring | |
Pre-Knowledge | X * | X ** | X ** | SurveyMonkey® | ||||
Smiles for Life Modules [1 h each] | Module Questions and Certificate of Completion | |||||||
1 = Oral to Systemic Health | X | X | ||||||
2 = Child Oral Health | X | X | X | |||||
5 = Pregnancy Oral Health | X | X | X | |||||
6 = CRA | X | X | X | |||||
7 = The Oral Exam | X | X | X | X | ||||
Didactic [Interdisciplinary; 5 h] | CRA Practice & Written Assignment with Anticipatory Guidance | |||||||
Oral Health Lecture | X | X | ||||||
CRA Lecture | X | X | X | |||||
Dental Trauma Brown Bag | X | X | ||||||
Skills Lab [Dentistry Fellows; 1 h] | X | Peer–Peer Learning Simulation | ||||||
Oral exam positioning | X | X | ||||||
Fluoride Varnish Application | X | X | ||||||
End-of-Program Evaluation | X | X | X | Focus Group SurveyMonkey® | ||||
Post-Knowledge | X * | X ** | X ** |
Variables. | Pediatric Medical Residents [n = 14] | Pediatric NP Students [n = 18] | Family NP Student [n = 49] | ||||||
---|---|---|---|---|---|---|---|---|---|
Characteristics | n (%) or Mean [SD] | ||||||||
Age, years | 28.8 [1.5] (range 27–32) | 28.7 [3.4] (range 24–38) | 30.7 [6.2] (range 23–49) | ||||||
Ethnicity | |||||||||
White | 7 (50%) | 7 (39%) | 17 (35%) | ||||||
Hispanic | 3 (21%) | 4 (22%) | 13 (26%) | ||||||
Asian | 3 (21%) | 6 (33%) | 17 (35%) | ||||||
Black | 1 (8%) | 1 (6%) | 2 (4%) | ||||||
RN Experience, years | N/A | 4.5 [2.4] (range 2–13) | 5.4 [3.7] (range 1–22) | ||||||
General Oral Health | |||||||||
Excellent | 3 (21%) | 4 (22%) | 10 (20%) | ||||||
Very Good | 2 (21%) | 10 (56%) | 13 (28%) | ||||||
Good | 5 (37%) | 2 (11%) | 25 (50%) | ||||||
Fair | 3 (21%) | 2 (11%) | 1 (2%) | ||||||
Attitudes | |||||||||
Pre | Post | p | Pre | Post | p | Pre | Post | p | |
How often do you brush your teeth? | |||||||||
Once daily | 2 (14%) | 2 (14%) | 0 (0%) | 1 (6%) | 3 (6%) | 3 (6%) | |||
>2 × a daily | 12 (86%) | 12 (86%) | 1.00 | 18 (100%) | 17 (94%) | 1.00 | 45 (92%) | 45 (92%) | 1.00 |
Every other day | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (2%) | 1 (2%) | |||
<3 × per week | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |||
Do you use fluoride toothpaste? | 0.366 | 1.00 | 0.425 | ||||||
Yes | 11 (79%) | 13 (93%) | 16 (88%) | 16 (88%) | 37 (76%) | 40 (82%) | |||
No | 1 (7%) | 0 (0%) | 1 (6%) | 1 (6%) | 4 (8%) | 3 (6%) | |||
Unsure | 2 (14%) | 1 (7%) | 1 (6%) | 1 (6%) | 8 (16%) | 6 (12%) | |||
How often do you floss your teeth? | 0.223 | 0.102 | 0.655 | ||||||
Once daily | 9 (65%) | 11 (79%) | 9 (50%) | 11 (61%) | 26 (53%) | 29 (60%) | |||
Once a week | 2 (14%) | 1 (7%) | 6 (33%) | 2 (11%) | 13 (27%) | 11 (22%) | |||
1–2 × month | 2 (14%) | 1 (7%) | 3 (17%) | 3 (17%) | 8 (16%) | 7 (14%) | |||
I do not floss | 1 (7%) | 1 (7%) | 0 (0%) | 2 (11%) | 2 (4%) | 2 (4%) | |||
How often do you visit the dentist? | 0.414 | 0.027 | 0.180 | ||||||
>2 × per year | 3 (22%) | 7 (50%) | 3 (17%) | 13 (71%) | 27 (55%) | 29 (59%) | |||
Once a year | 7 (50%) | 6 (43%) | 12 (67%) | 3 (17%) | 16 (33%) | 16 (33%) | |||
Every 2–3 years | 2 (14%) | 1 (7%) | 1 (6%) | 1 (6%) | 2 (4%) | 2 (4%) | |||
Only if problem | 2 (14%) | 0 (0%) | 2 (10%) | 1 (6%) | 4 (8%) | 2 (4%) | |||
Skills | |||||||||
Pre | Post | p | Pre | Post | p | Pre | Post | p | |
Is an oral exam part of your routine clinical practice? | 0.197 | 0.002 | 0.021 | ||||||
Most of the time | 4 (29%) | 4 (29%) | 1 (6%) | 10 (56%) | 10 (20%) | 8 (16%) | |||
Some of the time | 4 (29%) | 8 (57%) | 6 (33%) | 6 (33%) | 11 (22%) | 26 (53%) | |||
Rarely | 5 (35%) | 2 (14%) | 10 (55%) | 2 (11%) | 19 (40%) | 11 (22%) | |||
Never | 1 (7%) | 0 (0%) | 1 (6%) | 0 (0%) | 9 (18%) | 4 (9%) | |||
Do you use a caries risk assessment form in your clinical practice? | 0.002 | 0.001 | <0.001 | ||||||
Most of the time | 0 (0%) | 1 (7%) | 0 (0%) | 4 (22%) | 0 (0%) | 3 (6%) | |||
Some of the time | 0 (0%) | 3 (21%) | 1 (6%) | 6 (33%) | 0 (0%) | 6 (12%) | |||
Rarely | 0 (0%) | 7 (51%) | 2 (11%) | 5 (28%) | 8 (16%) | 13 (27%) | |||
Never | 14 (100%) | 3 (21%) | 15 (83%) | 3 (17%) | 41 (84%) | 27 (55%) | |||
Do you provide preventative dental education at pediatric visits? | 0.782 | <0.001 | <0.001 | ||||||
Most of the time | 11 (79%) | 10 (71%) | 1 (6%) | 15 (83%) | 2 (4%) | 9 (18%) | |||
Some of the time | 2 (14%) | 4 (29%) | 3 (17%) | 2 (11%) | 3 (6%) | 11 (22%) | |||
Rarely | 0 (0%) | 0 (0%) | 4 (22%) | 0 (0%) | 8 (16%) | 10 (20%) | |||
Never | 1 (7%) | 0 (0%) | 10 (55%) | 1 (6%) | 36 (74%) | 19 (40%) | |||
Do you assist families with referrals to dentists if needed? | 0.593 | 0.001 | <0.001 | ||||||
Most of the time | 10 (72%) | 10 (72%) | 0 (0%) | 9 (50%) | 2 (4%) | 8 (16%) | |||
Some of the time | 3 (21%) | 4 (28%) | 6 (33%) | 4 (22%) | 7 (14%) | 15 (31%) | |||
Rarely | 0 (0%) | 0 (0%) | 2 (11%) | 4 (22%) | 10 (20%) | 15 (31%) | |||
Never | 1 (7%) | 0 (0%) | 10 (56%) | 1 (6%) | 30 (62%) | 11 (22%) | |||
Have you had the opportunity to apply fluoride varnish in your clinical practice? | 0.416 | 0.058 | 0.239 | ||||||
Most of the time | 7 (50%) | 6 (44%) | 0 (0%) | 1 (6%) | 0 (0%) | 2 (4%) | |||
Some of the time | 1 (7%) | 3 (21%) | 0 (0%) | 1 (6%) | 1 (2%) | 1 (2%) | |||
Rarely | 1 (7%) | 2 (14% | 1 (6%) | 2 (11%) | 2 (4%) | 2 (4%) | |||
Never | 5 (36%) | 3 (21%) | 17 (94%) | 14 (77%) | 46 (94%) | 44 (90%) | |||
Knowledge | |||||||||
Pre | Post | p | Pre | Post | p | Pre | Post | p | |
Scores, mean Total (0–20) | 7.86 [2.4] | 14.0 [2.9] | <0.001 | 7.61 [2.7] | 15.8 [2.7] | <0.001 | 5.48 [2.8] | 12.6 [3.0] | <0.001 |
Change in Score (%) | 6.14% | 8.19% | 7.12% |
Pediatric Medicine Residents (N = 23) | |
---|---|
Themes | Supporting Quotes |
Attitudes towards the oral health training and Smiles for Life modules. | “Smiles for Life was really helpful. I thought that it was a great website to go to for resources too. It’s definitely something I’ll come back to when I need to look stuff up for my practice.” “I thought the photos [in Smiles for Life] were great…having a visual to take a look at, like, different tooth injuries and infections and was kind of a good clinical pearl to see.” “I think the modules were also very easily digestible—like we weren’t inundated with information, it was very brief, to the point, and exactly what we would need to know as pediatricians.” |
Application of the oral health training to current practice. | “The knee-to-knee exam I’ve been able to do a couple times and that’s been nice.” “So, I think it was good just to see what questions the dentists are asking and then which ones we can adapt to our practice, especially for the kids who don’t have a dental home which is a lot of our clinic patients.” “In terms of applying the fluoride, it was nice to see the strategies recommended to use…. So just learning specifically how they recommend, like, holding the child and then where on the teeth to start. I feel like that specifically was helpful.” |
Suggestions for program improvement. | “Making it more interactive and maybe even, you know, have a group of 10 residents we can break up into groups of three and then each practice more hands-on so that I kind of remember what to do when I’m in clinic versus the picture portion.” “Maybe if there were resources we could share with parents, like frequently asked questions or handouts or something like that, like something tangible we could get.” “Another thing I feel like we could’ve talked more about is how to help out patients who are underserved or vulnerable get access to dental care. Like talking more about the insurance situation when it comes to dental care or how available pediatric dentist who accept Medicare are, things of that nature.” |
Pediatric Nurse Practitioners (N = 23) | |
Themes | Supporting Quotes |
Application of the oral health training to current practice. | “I’ve gotten to apply like varnish before, and it was at a clinic where it wasn’t like standard practice to do that and because of the training, I kind of showed other providers how easy it was.” “On all my Well-child visits, I check their teeth and I look for white spot lesions and then I’ll say like, “Do you eat candy?” “Are you brushing your teeth?” And normally the answer is no, and so then we get to talk about that.” “Yesterday I had a two-month-old, and the parents didn’t realize that they were supposed to gently wipe down the gums, like in between feedings or like at least try to do it once a day, at the very least, so I was able to educate them on oral care.” |
Attitudes towards the oral health training and Smiles for Life modules/lectures. | “I thought it was really helpful, I never felt like we got proper dental education in nursing school.” “I kind of liked that we just got to do some modules on our own time. I think the modules were set up like, well—that you like go through, you take a quiz, and it helps you kind of just remember these little highlighted facts.” “So, like the modules gave me such good visual reference that now I look at kids and don’t just think like, “Okay, they’ve got some weird teeth.” But like now I can like actually look at their teeth and be like, “Okay, they’re this far into like having a cavity.” Or some plaque formation or if there’s something like really—give like guidance and be able to like accurately explain that to families gives like you more confidence.” “I think one strength is that this is like how we bridge the gap between like dentistry and medical care, because I really feel like there is a big disconnect between those two. But now I feel like there’s more of a connection because I understand what happens on the other side and what I can do to promote that.” |
Interprofessional experiences during the oral health training program. | “They’re just like knowledgeable and they really, I think, also understood our perspective, like even the dentist that lectured for us like he was trying to make it very understanding from the primary care perspective.” “They’ve [dentists] all been very willing to teach and explain things in a way that is applicable for us and like easy to understand, but also helped me understand the relevance too.” “To get it [information] from somebody that is a dentist coming from our program, being able to tell us like “Here if you need it.” I think that was beneficial.” |
Barriers to conducting a caries risk assessment. | “Time constraints.” “With the old school doctors, there’s not really a lot of emphasis on the dental stuff, so they don’t necessarily prioritize it.” “I think, with like our clinic, our kids are so complex with like DCFS involvement and things like that and such low resources already that sometimes dental and oral health gets kind of put on the back burner if we’re just trying to get them vaccinated… or up to their goal weight... So, those things can take up the whole time that we have with them and the least of our worries sometimes can be their teeth, you know.” |
Family Nurse Practitioners (N = 42) | |
Themes | Supporting Quotes |
Program strengths. | “I think one thing for me was the link between oral health and systemic health. I think that was in the very—one of the very first like Smiles for Life modules that we did was like, the link between like oral health and systemic inflammation and kind of how everything kind of plays into each other.” “One thing that really stuck out to me was just learning that kids should be going to see a dentist as early as like their first tooth eruption or the first year of life, which I hadn’t really realized.” “For me it was the caries risk assessment and then just like the risk of caries that can have on kids and then feeling empowered that I could actually do something aside from referring to the dentist in clinic, which is the varnish application.” “Being able to apply varnish and being taught how to apply varnish. I thought that that was really helpful as well in improving the outcomes for our patients.” “It’s kind of nice that it’s spread out across multiple quarters instead of just being jammed into one lecture on one day. So, it’s just kind of like little bites at a time.” |
Interprofessional experiences during the oral health training program. | “I really appreciated having the interdisciplinary interaction with a dentist at our simulation lab. But I wish we had more interaction with the dentistry school during this, especially in a small group setting, because I think that would help clarify the information and help us bridge that gap that we often see between the medical world and the dental world.” “I think just through nursing experience and watching physicians, sometimes physician specialties or other specialties don’t want you to touch their area, and so, I found it really helpful to have actual input and feedback and training from the dentist.” “I think there’s a lot of myths that, you know, primary care providers and dentists don’t really speak to each other or refer. And so, I think it was really good to meet the dentist and you know, make sure that we’re all on the same page, and that’s really to help our patients and prevent any diseases that may come up with, with oral care, dental care and things like that.” |
Suggestions for program improvement. | “If we could cut down on that online curriculum and then have like one hour-long in-person thing per quarter over the first year instead of the online stuff. I think it would probably like stick better, honestly.” “If maybe we were able to do the caries risk assessment in a simulation in class, I think that would’ve been more appreciated by us just because we all like the simulation’s lab, versus like sitting down and writing a paper, which, you know—I think we would just retain better if we had the in-person visual audio and tactile.” “Just the timing of the actual modules, definitely makes a huge difference. Being more aligned with our pediatrics class and then, maybe having us do them like at the very beginning of the quarter when we don’t have a ton of other work to do at the time might be helpful.” |
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Share and Cite
Love, L.; Ramos-Gomez, F.; Kinsler, J.J.; Cabrera-Mino, C.; Garell, C.; Pike, N.A. Oral Health Knowledge, Attitudes, and Learned Clinical Skills in Pediatric Medicine Residents and Nurse Practitioner Students: A Pre-Post Design. Healthcare 2024, 12, 1807. https://doi.org/10.3390/healthcare12181807
Love L, Ramos-Gomez F, Kinsler JJ, Cabrera-Mino C, Garell C, Pike NA. Oral Health Knowledge, Attitudes, and Learned Clinical Skills in Pediatric Medicine Residents and Nurse Practitioner Students: A Pre-Post Design. Healthcare. 2024; 12(18):1807. https://doi.org/10.3390/healthcare12181807
Chicago/Turabian StyleLove, Laurie, Francisco Ramos-Gomez, Janni J. Kinsler, Cristina Cabrera-Mino, Cambria Garell, and Nancy A. Pike. 2024. "Oral Health Knowledge, Attitudes, and Learned Clinical Skills in Pediatric Medicine Residents and Nurse Practitioner Students: A Pre-Post Design" Healthcare 12, no. 18: 1807. https://doi.org/10.3390/healthcare12181807