Evaluating Training of Oral Physicians

Objective:

To demonstrate the efficacy of training general practice dental residents (GPDRs) to become oral physicians (OPs) providing limited preventive primary care.

Method:

Program evaluation included:  residents’ knowledge and skills, and  patient and physician attitudes towards OPs and primary care. Nineteen residents from Harvard-affiliated Cambridge Health Alliance (CHA) and Brigham and Women’s (BWH) hospitals participated. The GPDR-OP curriculum includes physical diagnosis, interviewing skills, and Pediatrics, Internal Medicine, Anesthesiology, Oral Surgery, and Emergency Medicine. Evaluation consisted of standardized faculty assessment of knowledge and performance; GPDR-OP objective tests of primary care medical knowledge; and qualitative analysis of videotaped interviews of patient-doctor interaction with trained patients. Attitudes and beliefs of patients being treated by the GPDR-OPs were compared with those of patients treated by staff dentists.  Medical faculty, dental staff, and GPDR-OPs themselves also evaluated the program.   As a research training exercise, GPDR-OPs presented an OP-related literature review.

Result:

GPDR-OPs’ pre-test to post-test scores of medical knowledge increased an average of 32.0%. The pre-training medical knowledge scores of the CHA GPDR-OPs’ tests in 2010 were 13.1% lower than BWH GPDRs, with no difference between pre-test scores in 2011. Post-test scores for BWH were not available.  Unfortunately medical knowledge was not included in the selection of OP residents.  Interviewing skills markedly improved, including the discussion of sensitive information not usually the province of dentists.  

Conclusion:

Training GPDR-OPs in a one-year program to include limited preventive primary care has been successfully demonstrated, together with increasing physician awareness of the importance of oral to overall health. With few exceptions, teaching physical diagnosis to dental residents should be at a level similar to that of a second-year medical student.  The acceptance by health care providers and patients of dentists as OPs providing limited preventive primary care including medical screening continues to be a surmountable challenge.