By Nicole Fauteux
What do you do when your dental school trains its students in evidence-based practice, then releases them into a practice environment where senior clinicians are unfamiliar with the concept or maybe even a little intimidated by it? You just might devise a continuing education (CE) course to bring practicing professionals into the evidence-based fold. That’s what faculty members at the University of Iowa College of Dentistry did, and in just two years they have already reached 867 oral health professionals.
It all started in 2009 when adjunct faculty who were concerned about staying up-to-date with published scientific literature requested training in evidence-based dentistry (EBD). Dr. Teresa A. Marshall, who had been teaching EBD to first-year dental students, and Dr. Cheryl Straub-Morarend, who had been encouraging fourth-year students to employ their EBD skills in clinic, decided it was time to take EBD into the realm of CE. With their colleagues Dr. David C. Holmes and Dr. Michael W. Finkelstein, they conducted a survey of all of Iowa's practicing dentists, 80% of whom are Iowa graduates. Then, with information in hand about dentists’ practice patterns, attitudes, knowledge, and behaviors, the team set about designing a CE course in EBD.
The resulting course strives to equip the dental team with efficient strategies to address gaps in clinical knowledge. Participants learn to distinguish scientific sources from lay sources of information and become acquainted with the best online resources. They learn to formulate clinical questions, search for current evidence, and evaluate the evidence they find. The course also touches on how the dental team can integrate evidence with their clinical experience and their patients’ preferences at the point of care.
“Unfortunately, EBD is not a topic health professionals think of first when they think of CE in dentistry,” says Dr. Straub-Morarend. Nevertheless, the team found a large audience through two of the college’s adjunct professors who were also officers in their dental district component societies. Both arranged for the course to be offered in their districts. One of these, Des Moines, drew 600 dental professionals. Two smaller classes followed that were tailored to the specific interests of the particular groups.
Despite their large size, the classes were highly interactive. Dental offices were encouraged to attend the course as a team and to bring their computers. The instructors used an audience-response system to engage attendees at the beginning of the program, presented clinical vignettes, and gave teams opportunities to collaborate on writing structured questions and initiating an online search.
“We found these teams of dentists, hygienists, and assistants had no structured format for identifying and retrieving scientific information,” says Dr. Straub-Morarend. “They did not know where to look for valid, reliable scientific information or what resources they should use with the limited time they had. Our focus was on creating a structured format for them.”
The decision to engage office teams rather than dentists alone proved fortuitous, given the diversity in computer literacy among the participants. Even without this benefit, Dr. Marshall believes that it is important for staff members, especially those charged with patient education, “to understand the need for evidence. They are the front line with patients. They're the ones who hear all the misconceptions.”
Dr. Marshall got an even closer look at the challenges of educating practicing professionals in EBD when she offered the course through a journal club for a more intimate group of 25 participants.
“A number of them found the whole topic overwhelming,” she recalls. “A couple of them alluded to the fact that they did not read the literature regularly, so to go in and critique it and find this information was difficult. They felt it was much easier to go to a CE course to find out what to do.”
Dr. Marshall’s observation coincides with findings of the survey that she and her colleagues conducted. It asked dentists which resources they used most and which they most preferred. Print journals, asking a colleague, and CE courses ranked highest. Accessing electronic resources ranked lowest on both lists.
Drs. Marshall and Straub-Morarend expressed optimism that, were they to conduct their survey today, the use of electronic resources would be on the rise. “I hope with our CE efforts that we would observe an increased use of library databases, a higher confidence with assessment of resources, and health care professionals engaging their colleagues in evidence-based decision-making to address gaps in clinical knowledge,” said Dr. Straub-Morarend.
Next up for the dynamic duo is the development of an online course that will reside in the dental school library. The focus will be on how to engage in evidence-based practice and where to find and access available resources. In the meantime, they are looking to continue offering the in-person CE course in other dental districts throughout the state.
Interested in learning more? You can access the Iowa team’s ADEA 2012 Annual Session presentation detailing their survey and their CE course. They also invite those interested in establishing similar programs to contact them for more information.