Perspective of staff on student outreach placements
Department of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, UK. European Journal Of Dental Education
(Impact Factor: 0.94).
03/2006; 10(1):44-51. DOI: 10.1111/j.1600-0579.2006.00388.x
To explore the perspectives of placement staff on outreach training.
Block clinical placements in primary care settings for dental undergraduates and hygiene and therapy students.
After completion of the placements, 32 participating staff across nine primary care locations took part in qualitative interviews and focus groups. The staff provided data on placement organisation, the students' development and their supervision, and any effects on themselves as hosts.
The major themes included the learning environment, supervision and communication. The staff saw benefits to students in working in a smaller primary care clinic with nursing support and immediately available supervision by a dental generalist. Other benefits included increased confidence, broader clinical experience and applying theoretical learning to new communities. Effective communication and adequate resourcing were critical success factors. There was some disruption of clinics' normal working, but many unanticipated benefits. Staff supported the outreach placements in primary care settings to enhance students' dental education.
These findings provide a planning and evaluation framework for dental educators involved in outreach.
Available from: Amanda Lecouteur
- "When the project began the existing activity system of the clinic was based around the object of delivering high quality patient care. In theory, participants understood the importance of training future dentists, but in practice, team members were highly focused on clinical tasks . Student supervision was viewed as an activity undertaken by dentists, not the team as a whole, and as a disruption or impediment to clinical activity. "
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The aim of this project was to explore the process of change in a busy community dental clinic following a team development intervention designed to improve the management of student supervision during clinical placements.
An action research model was used. Seven members of a community dental clinic team (three dentists, two dental therapists, one dental assistant and the clinic manager), together with the university clinical placement supervisor participated in the team development intervention. The intervention consisted of two profiling activities and associated workshops spread six months apart. These activities focused on individual work preferences and overall team performance with the aim of improving the functioning of the clinic as a learning environment for dental students. Evaluation data consisted of 20 participant interviews, fourteen hours of workplace observation and six sets of field notes. Following initial thematic analysis, project outcomes were re-analysed using activity theory and expansive learning as a theoretical framework.
At project commencement students were not well integrated into the day-to-day clinic functioning. Staff expressed a general view that greater attention to student supervision would compromise patient care. Following the intervention greater clinical team cohesion and workflow changes delivered efficiencies in practice, enhanced relationships among team members, and more positive attitudes towards students. The physical layout of the clinic and clinical workloads were changed to achieve greater involvement of all team members in supporting student learning. Unexpectedly, these changes also improved clinic functioning and increased the number of student placements available.
In navigating the sequential stages of the expansive learning cycle, the clinical team ultimately redefined the ‘object’ of their activity and crossed previously impervious boundaries between healthcare delivery and student supervision with benefits to all parties.
Available from: 9thnrhc.ruralhealth.org.au
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ABSTRACT: Access to dental care in the predominantly rural state of Tasmania remains challenged by the shortage of dental professionals. Without a dental school, Tasmania is dependent on dentists who have relocated from interstate or overseas. Within the public sector, which experiences intractable problems with recruitment and retention of dentists, dental visit patterns are characterised by a high proportion of episodic urgent care, lengthy waiting lists for comprehensive care and absence of recall. Coping with the level of demand for urgent care is a crucial element facing rural public dental services and the factors that underpin access to services and patient visit interactions are directly related to this level of demand. Recently, Tasmanian government-employed dentists argued that they were only 'fire-fighters' who attempt to manage patient load/time management in response to patient's general health, urgent dental needs and perceived levels of interest in oral health care. There were strong indications that expanding the capacity and the flexibility of the workforce would contribute to improved interactions with patients and improve access to a broader range of dental care within public sector clinical services. A unique agreement between the University of Tasmania and the Tasmanian Government in 2005 considered an innovative method to attract new dental graduates to Tasmania. In partnership with the University of Adelaide, the agreement set in motion an ongoing formal clinical attachment and scholarship scheme for dental students to undertake part of their final year of the Bachelor of Dental Surgery in the Tasmanian public sector. The objectives of this program included a concerted attempt to minimise the 'firefighter' perception of rural public dentistry. In this paper, the overarching problem of improving access to appropriate and affordable health care for rural communities is discussed in the context of government salaried dentists' perception of themselves as 'firefighters'. A strategy to address this perception, the clinical placements for final year dental students, is described and the results of a qualitative evaluation of the first cohort are analysed. The evaluation identified host benefits of the program including raising the profile of best practice and increasing staff sense of worth. In addition to high quality experiential learning opportunities, the placement program increased the capacity for autonomous clinical decisions, continuity of care and improved social interaction during dental visits as ways to minimise the perception of public sector dentists as 'fire-fighters'.
Available from: Peter G Robinson
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ABSTRACT: Dental schools are developing new curricula, with outreach placements enhancing the hospital-based training.
To assess the students' experience of outreach as one component of determining the value and feasibility of outreach placements.
Six-week block placements for 10 undergraduates and 3 weeks for 11 hygiene and hygiene and therapy students in existing primary care clinics, in areas of need, to work supervised by local dentists.
Semi-structured interviews with 20 students by staff independent of the course team. Interviews were audio-recorded, transcribed and content analysed before being verified by a second observer. Findings were triangulated against a peer-run focus group and students' clinical records.
Students were very positive about their experience and the potential role of outreach training in dental education. They described: gaining greater experience of new types of patients and their communities; learning from broader clinical experience, alternative approaches and practicing or observing dentistry in different settings; the benefits of team working; and, acquiring a more holistic and pragmatic view of health care. Many students reported gaining greater confidence, wider awareness of potential careers in dentistry and a greater sense of realism in their experience. Some reflected on their own training needs. Students also discussed the importance of preparation for the placements and the merits of different styles of supervision.
Dental outreach training can provide students with valuable learning experience in a range of areas. It requires careful management to ensure those experiences match individuals' needs and the programme's purposes.
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