ADEA CCI Liaison Ledger

Educator Spotlight: Prof. Diane Brunson, Director of Public Health and Community Outreach, The University of Colorado School of Dental Medicine

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By Janet Hulstrand

“If a dentist could call a physician and say, ‘I currently have our patient in the chair, and this is what’s going on,” Diane Brunson, RDH, M.P.H., says, “that would take us so much further down the road in terms of [improved] health outcomes.” 
Diane Brunson

As former Colorado State Dental Director and Past President of both the American Association of Public Health Dentistry and the Association of State and Territorial Dental Directors, Prof. Brunson is in an excellent position to evaluate the potential of interprofessional education (IPE) and collaborative care. 

“My background has made me a believer,” she says, adding, “In many ways IPE is a public health approach to improving overall health.”

Given this perspective, is it any wonder that Prof. Brunson was tapped by The University of Colorado (CU) School of Dental Medicine (SDM) to serve as Director of Public Health and Interprofessional Education? 

CU’s state-of-the-art Anschutz Medical Campus has many advantages when it comes to teaching interprofessional collaboration. The campus was designed to facilitate IPE, with students from all the health professions programs sharing facilities. But despite this strong foundation, CU has experienced many of the challenges other schools face in implementing IPE. 

From her vantage point as a representative to CU’s IPE Council, Prof. Brunson has seen most of them. The first was getting all of the schools on—“or at least close to”—the same academic calendar so that every student would be available for IPE on the same afternoon each week over the course of two semesters. To achieve this synchronization, schools needed to adjust their didactic lecture and experiential rotation schedules. 

“That didn’t happen overnight,” Prof. Brunson says. “We accomplished this because the offices of the Chancellor and Vice Chancellor for Health Affairs stated this was a priority.” Even so, the calendars are still not perfectly aligned, although the introduction of an online component to the IPE curriculum has solved the problem for the present.

Another major challenge has been finding faculty who can afford the time needed to train for and then facilitate IPE classes, which use team-based learning. “Most of our faculty have significant clinical responsibilities with upperclassmen,” Prof. Brunson says, explaining that it takes at least five hours a week to serve as a facilitator for the first- and second-year IPE program—time most clinical faculty simply don’t have. She says CU has had some success recruiting from the community, including outside the health professions. “Some of our best facilitators are lawyers and hospital chaplains,” she reports. 

Within dentistry, there’s also the need for a greater emphasis on intraprofessional training. Inspired by the keynote address given by Judith Buchanan, D.M.D., Ph.D., M.S., at the 2013 ADEA CCI Summer Liaisons Meeting, Prof. Brunson arranged for senior dental hygiene students from the Community College of Denver to work in teams with second-year dental students last semester. They were assigned a periodontology case that emphasized roles and responsibilities within the dental team. Prof. Brunson plans to repeat the exercise in the fall and hopes to involve a dental assistant program as well.

“As a dental hygienist, Prof. Brunson brings great passion to the intra- as well as interprofessional team interactions that strengthen education, research and patient care,” says Denise Kassebaum, D.D.S., M.S., Dean of CU SDM. “Throughout her career, she has promoted the value of teamwork and interprofessional collaboration in the practicing dental community, in community partnerships, and in state government, as well as in our classrooms and clinics.” 

Despite her successes in these venues, Prof. Brunson sometimes finds it hard to communicate the value of collaboration to dental students. “We’re asking students to envision a new type of dental practice that frankly doesn’t exist in many places yet,” she says. The first orientation to CU’s nascent IPE program exemplified the problem. The case of “Bill,” a man with diabetes who is hospitalized for a kidney infection, was well received by her colleagues, but Diane saw a serious deficit. 

“Nothing was mentioned about dental,” she recalls, “and I had 52 dental students in the audience.” She immediately approached the director, who invited her to edit his slides to give the case an oral health dimension. “That’s how I got my nose into this,” she says.

Her experience as a dental hygienist working in a very intraprofessional private practice many years ago has helped her to visualize what collaborative practice should look like and how dentistry fits into the bigger picture.

“The safety net clinics, particularly community health centers, come closest to the model we’re trying to instill,” she observes, “but even they are not really sure how to practice interprofessionally. Many clinics have services collocated, but not really integrated.”

Nevertheless, she tries to convey to her students that the health care system is changing. “Dentistry has been pretty siloed in the past,” she tells them, “but there’s going to be more and more demand for patient-centered care. Our students are going to have to know how to collaborate with other health professionals. We want to be sure they’re ready for the coming changes, so they can succeed.” Finding faculty members who see what dentistry could look like as part of interprofessional practice is one key to moving IPE forward. 

To ensure that CU’s IPE program is meeting its goals, the IPE Council has introduced evaluation tools and processes that go beyond those used by the university to assess other programs. In addition to typical course evaluations, students use a tool created by CATME SMARTER Teamwork, which allows them to evaluate themselves and the other members of their team. Prof. Brunson hopes to eventually find a way to use the data collected to see whether large discrepancies between peer- and self-evaluations might predict difficulties students may encounter during the clinical years.

The IPE Council has also brought in outside evaluators from the CU School of Education and Human Development to help evaluate the IPE program. “That’s been really helpful in figuring out where the potential problems are, so we can address them now, not find out years down the road that we’re not meeting the needs of our students,” she says. 

Some of the ideas that have arisen through the evaluation process include:

  • Having schools spend more time preparing students for their first IPE experience.
  • Tapping general practice residents who are CU graduates to explain the merits of IPE to dental students.
  • Asking dental faculty to develop more cases (perhaps related to drug addiction or oral cancers) that allow dentists to make medical diagnoses.
Prof. Brunson believes such cases would help dental students become more invested in IPE by demonstrating its relevance.

Many thanks for the information and congratulations on your success Prof. Brunson!

I am in the process of working on a grant proposal to develope a program to enable nurse practitioner and dental hygiene students to provide oral health screenings and education in a hospital ED located in a rural county with a high low-income population with most of the county's public water system NOT fluoridated. Do you have any information you can share that would strengthen our proposal?

Thank you,
Lisa
Posted by: Lisa Bress, RDH, MS at 5/21/2015 8:33 AM


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