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Campus Spotlight: University of Tennessee Health Science Center College of Dentistry

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By Debra Werrlein

What would you do if confronted with a case of oral gonorrhea in a seven-year-old child? Thirty years ago, Chris Ivanoff, D.D.S., met with this horrific reality just three weeks out of dental school, and he was ill-prepared for the encounter. He did not recall anything in the dental school curriculum informing him that oral gonorrhea in young children is indicative of sexual abuse, nor anyone telling him what to do if he suspected abuse in a patient. Worse, when he reported the situation to his boss, he was told not to get involved.

UTHSC College of Dentistry Spring 2016

Three decades later, and at a time when the U.S. Department of Health and Human Services estimates that 3.2 million children are the subjects of child abuse and neglect reports each year, Dr. Ivanoff, now Associate Professor of Bioscience Research and Director of Global Outreach at the University of Tennessee Health Science Center College of Dentistry (UTHSC COD), has partnered with his Dean, Timothy Hottel, D.D.S., M.S., M.B.A., to devise a curriculum that provides dental students at UTHSC COD with comprehensive training for recognizing and addressing suspected child abuse and neglect (SCAN).

The SCAN curriculum at UTHSC COD is unique in its level of integration. Most dental schools provide students with between one and three hours of training on SCAN. The UTHSC COD curriculum aims instead for a continuum of training that includes traditional lectures and problem-based learning (PBL) in the early predoctoral years, followed by a combination of PBL sessions and case presentations in the later predoctoral years. 

As a first step in implementing the curriculum, its creators called for the integration of SCAN material into courses such as physiology and epidemiology. “This is the easy part of integration,” says Dr. Ivanoff, “because much of the necessary information is already worked into the course.” 

Existing information about the medical causes of abnormal bruising patterns or spontaneous bone fractures takes on new meaning when students are asked to consider that these presentations could result from abuse. Of course, abuse is not the cause of all injuries or lesions. 

“The aim is to build critical thinking skills, professional judgment and knowledge of the child to help students discern whether what is observed is accidental in nature or suspicious,” says Dr. Ivanoff.

In addition to this enhanced instruction, predoctoral students at UTHSC COD currently receive three different lectures related to SCAN: one on the behavioral signs of possible child abuse, another on child abuse that includes body markings, such as bite marks, and a third on oral surgery and pediatric trauma. 

In addition, predoctoral clinical training incorporates SCAN into weekly group meetings. Newly formalized in 2016, the group meetings include fourth-year dental students, who review and present case studies on actual patient scenarios to their peers and other faculty. “These types of active learning experiences are crucial to helping students think critically and ask questions,” says Dr. Hottel.

Students who pursue residency programs at UTHSC COD are also exposed to the SCAN curriculum, first through one lecture and two PBL sessions and then through a role-playing simulation in which they discuss possible child abuse with parents and with children. Simulations are videotaped and played back to the group for further discussion. 

Dr. Hottel identifies the simulation resources as an area of strength for SCAN. “We are lucky to have a large population of actors already in place who can role-play,” he says. “These exercises generate ideas. They bring to light things we might not have thought of otherwise.” And the program is expected to grow. In 2013, the university committed $25 million to erecting a new facility dedicated entirely to simulation and multidisciplinary PBL for the dental, medical, nursing, pharmacy and allied health colleges.

Drs. Hottel and Ivanoff concede that it takes time to make the kinds of changes they envision. One particular challenge arises from the need to standardize instruction. “In a PBL environment, it’s important to ensure that all instructors are on the same level of proficiency with regard to SCAN,” says Dr. Ivanoff. “Since all preceptors for clinical instruction are general dentists, this requires teaching them a new methodology, an endeavor that will take time and patience.”

Despite such challenges, Dr. Hottel is confident that “in the next few years, we will be able to build an excellent clinical skill level—in our predoc students and post-doc residents both in SCAN and adult abuse.”

The aim, they say, is not only to equip the next generation of dentists with the skills needed to recognize the signs of mental and physical abuse, but also to ensure that these dentists know how and when to address the issue with families and report suspicions to authorities—while also advocating and caring for the patient.

That list of objectives may sound long, but Drs. Hottel and Ivanoff are undaunted. “It is our moral duty to better prepare our students,” says Dr. Ivanoff, recalling his experience as a young dentist, “because no child who comes into this world deserves to be abused in such horrible ways.”


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