J Dent Educ. 70(12): 1316-1319 2006
© 2006 American Dental Education Association
Critical Issues in Dental Education |
A Twenty-Year Follow-Up Survey of Medical Emergency Education in U.S. Dental Schools
Morris S. Clark, D.D.S.;
Benjamin E. Wall, B.S.;
Tad C. Tholström, D.D.S.;
Edward H. Christensen, D.D.S.;
Brandon C. Payne, D.D.S.
Key words: medical emergency education, dental education, survey
Submitted for publication 12/14/05;
accepted 09/05/06
 |
Abstract
|
|---|
This article reports the results of a 2003 survey of medical emergency education taught in U.S. dental schools and compares the results to findings from surveys conducted in 1983 and 1992. A questionnaire was sent to the deans of all U.S. dental schools, requesting completion of the survey by the faculty member responsible for medical emergency education. Forty-three of fifty-four U.S. dental schools responded, and the data were compared to similar surveys conducted in 1983 and 1992. Special attention was given to changes in technology (pulse oximetry and automated external defibrillators), teaching methods (audiovisual, role-playing, and simulation), and subject matter (CPR, venipuncture, and endotracheal intubation) that affect medical emergency education. The study found a large disparity in number of hours dedicated to medical emergency training among dental schools. Surprisingly, CPR certification/recertification for both students and faculty was not provided at three of the reporting U.S. dental schools. Most schools included venipuncture and endotracheal intubation in their curriculum. Routine monitoring of vital signs remained fairly consistent over the past twenty years with a slight dip in the 1992 survey. A standardization of medical emergency education needs to take place to ensure an appropriate level of training for all dental students.
Twenty years have passed since an original thirty-nine-item questionnaire concerning medical emergency training and curriculum was sent to the then sixty dental schools in the United States.1 The original and the nine-year follow-up surveys were motivated by attention given to this subject by the dental education community.1,2 In 1977, the 54th House of Delegates of the American Association of Dental Schools (now American Dental Education Association) approved Resolution 23-77-H, which states:
Resolved, that member institutions be urged to include in the dental school curriculum instruction in medical emergency care and cardiopulmonary resuscitation; and be it further Resolved, that this Resolution be transmitted to the American Dental Association Council on Dental Education and to the National Dental Curriculum Conference.3
In this action, the Council of Students, which proposed the resolution, clearly stated that medical emergency training should be an integral part of the U.S. dental school curriculum. Guidelines for the curriculum pertaining to the management of medical emergencies were first published in 1981 and revised in 1990.4,5 Curriculum standard 2-27 (formerly standard 2-26) of the Commission on Dental Accreditation states: "Graduates must be competent in providing appropriate life support measures for medical emergencies that may be encountered in dental practice."6 Though guidelines have been given, much has been left to each individual institution to determine how to implement medical emergency training. Clearly, preparing dental students to prevent, recognize, and respond to a medical emergency is imperative to their dental training and subsequent practice life.
Medical emergencies are not rare in the dental office as described by Fast et al. in 1986 and Malamed in 1992. These studies revealed:
A total of 4309 survey respondents from all 50 U.S. states and 7 Canadian provinces reported 30,608 emergencies over 10 years. Of those, 96.6% answered positively to the following question: "In the past ten years, has a medical emergency occurred in your dental office?" (Doctors used their own definitions of emergency situations).7,8
Finally, it is important to recognize that the administration of local anesthetic requires medical emergency training. The "Warning" section of the Lidocaine HCl 2% and Epinephrine 1:100,000 insert pamphlet states:
Dental practitioners who employ local anesthetic agents should be well versed in diagnosis and management of emergencies that may arise from their use. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use.9
A survey of dental school seniors of the 2003 graduating class revealed that between 16 and 17 percent of the responding students felt that an inadequate amount of time was dedicated to medical emergency training in their dental schools’ curricula.10 Our own surveys of U.S. dental schools in 1983, 1992, and 2003 revealed an overall excellent medical emergency training, but at the same time displayed some serious underdevelopment in programs for preparing students to diagnose, treat, and manage medical emergencies in dental offices.1,2 This article reports the results of a twenty-year follow-up survey of U.S. dental schools to reassess, examine, and measure the progress of medical emergency education.
|
Methods
|
|---|
Ours was a voluntary population-based survey of fifty-four accredited United States dental schools in operation in 2003. Surveys were sent to the deans of these institutions, with a request that the questionnaire be completed by the person(s) responsible for the medical emergency care curriculum, similar to the surveys in 1983 and 1992. Forty-three of the solicited schools responded, resulting in a 79.6 percent response rate. One follow-up mailing was required to attain this level of participation. While compliance was excellent, the response rate was down from the 1983 and 1992 surveys of 91.5 and 93 percents, respectively. Survey data were transferred to a database using a dual data entry process. Prior to analysis, data were screened one variable at a time for improbable or outlying values. The primary areas of concern and those addressed by the questionnaire were curriculum, clinic practice, and school policy.
|
Results
|
|---|
Currently, most medical emergency training in U.S. dental schools is provided as a separate course within the curriculum (twenty-two schools out of forty-three, or 51.2 percent, reporting—an increase from 38 percent in 1983 and 39 percent in 1992). The remaining institutions integrated this training into a larger course or into several different courses. The majority of medical emergency training (53.5 percent) occurred in the second and third years of dental school. The total number of hours dedicated to medical emergency training ranged from three to sixty hours. The calculated mean and standard deviation of curriculum hours were 19 and 12.6 respectively. This was slightly down from the 1992 results (mean=22 hours and standard deviation=21 hours). Nearly 70 percent of the dental schools spend more than ten hours on medical emergency training (Table 1
), compared to 56 percent in 1983 and 92 percent in 1992. The medical emergency training is a required course at forty-one out of the forty-three (95.3 percent) reporting institutions. An oral and maxillofacial surgeon is the primary instructor for the medical emergency course at 60.5 percent of the responding dental schools. No other type of practitioner was significantly represented as the primary instructor.
Lecture was still the common teaching method (forty-one of forty-three; 95.3 percent) as in the 1992 survey (forty-nine of fifty-one; 96 percent). Role-playing and simulation increased markedly from 43 percent in 1992 to 62.8 percent (twenty-seven of forty-one) in 2003. Advances in the sophistication of audiovisual technology may account for its marked increase in utilization. For example, the use of slides or PowerPoint had increased from 57 percent in 1992 to 74.4 percent in 2003. Other popular ways to teach medical emergency training included mock problem solving (39.5 percent), videotapes (34.9 percent), and seminars (20.9 percent).
The teaching of venipuncture, endotracheal intubation, pulse oximetry, and automated external defibrillators (AED) varied among reporting schools (Table 2). Pulse oximetry and AED were not part of the questionnaire in 1983 and 1992. The 2003 survey revealed that pulse oximetry was at least briefly discussed in the curriculum in all but five of the reporting schools (88.4 percent). While the AED is relatively recent technology, over 90 percent of the schools reported that they provided instruction in this device.
In the 1983 and 1992 surveys, all schools reported offering courses in cardiopulmonary resuscitation (CPR). Alarmingly, the 2003 survey revealed that three schools (approximately 7 percent) stated that a CPR course was not included within their school curriculum (Table 2
). Furthermore, the 2003 questionnaire revealed that a CPR recertification course was not offered to students at three (7 percent) of the participating institutions. Two schools reported CPR recertification was not available to faculty. These data represent a significant increase from 1983 when 33 percent of the students and 22 percent of the faculty did not have CPR recertification programs offered in the school curriculum.
Routine monitoring of vital signs (blood pressure and respirations) was approximately the same in 1983 and 2003 although slightly lower in 1992 (Table 3). Thus, it appears that most dental schools have required students to monitor routine vital signs for the past twenty years. By contrast, modest improvement had been made since 1983 and 1992 in the formulation of policy for medical emergency orientation for students and faculty (Table 4).
|
Discussion
|
|---|
Continued reevaluating of medical emergency education in U.S. dental schools is imperative. The response rate of 79.6 percent shows that dental institutions are interested and genuinely concerned about their medical emergency curricula. Data from the study by Fast et al.7 indicate that every dentist will have an opportunity to treat a medical emergency in his or her lifetime whether at home, at work, or in some other setting. The outcome of each medical emergency may depend upon the training he or she received in dental school. Without question, this is the most important aspect of training a student will receive while gaining a dental education because of the life-threatening nature of many medical emergencies.
The data from the 2003 survey revealed positive aspects regarding the status of the medical emergency curriculum including the following findings: a mean of nineteen teaching hours, students being expected to routinely monitor vital signs, and coursework that helps students learn how to recognize pathophysiological events.
There were several areas of particular concern found in the survey. Although pulse oximetry use in the dental office is relatively new technology, it is necessary to meet the standard of care when performing IV sedation and treating the medically complex patient. In addition, the use of the AED is now the standard of care in cardiac arrest emergencies and should be present in all dental offices. Unfortunately, these devices were not discussed at all reporting schools. Not every school had CPR certification or recertification classes provided by the institution for students and/or faculty. While all reporting dental schools possessed an emergency cart, not all carts were located within the clinic, and schools reported that students and staff were not always trained in how to use the cart for medical emergency situations. Two institutions reported that they provide medical emergency training as an "elective" class in their dental school curricula.
Teaching students to form good patient management habits and practice tendencies while in dental school is crucial to helping students prevent, minimize, and treat medical emergencies throughout their dental careers. Dental educators need to be highly involved and deeply concerned about the quality of medical emergency education students receive at their institutions. Information and teaching methods must be shared among institutions to strengthen student learning and improve presented material. With an increase in communication among U.S. dental schools, the medical emergency protocol, policy, and curriculum may become more standardized.
Due to advances in the practice of medicine and an aging population, the profile of patients seeking dental care is becoming more medically complex. The frequency of occurrence of medical emergencies in dental offices speaks to the need to determine patient risk by consistently taking and recording vital signs.8 It is the responsibility of dental programs to provide future dentists with the education and experience necessary to develop the skills needed to respond to a medical crisis. While not specifically mandated by the ADA for accreditation, dental schools should provide CPR certification/recertification as well as knowledge and experience in pulse oximetry, AED, and developing an emergency response plan. Preventing every potential medical emergency is not feasible even under the care of the best trained practitioner. Thus, every U.S. dental school must ensure that each student is capable, educated, and trained to effectively diagnose and manage any medical emergencies that may arise both in and out of the dental office.
|
Footnotes
|
|---|
Dr. Clark is a Professor, Department of Surgical Dentistry, and Director of Anesthesia, University of Colorado School of Dentistry, Lazzara Center for Oral/Facial Health; Mr. Wall is a fourth-year dental student, University of Colorado School of Dentistry; Dr. Tholström is a first-year general practice resident in the United States Air Force; Dr. Christensen is a first-year oral and maxillofacial surgery resident at the University of Oklahoma Health Science Center; and Dr. Payne is a second-year oral and maxillofacial surgery resident at the University of Missouri-Kansas City. Direct correspondence and requests for reprints to Dr. Morris S. Clark, University of Colorado School of Dentistry, P.O. Box 6508, Mail Stop F830, Aurora, CO 80045; 303-724-6975 phone; 303-724-6986 fax; morris.clark{at}uchsc.edu.
|
REFERENCES
|
|---|
- Clark MS, Heine CS, Fryer GE Jr. Medical emergency education in American dental schools. J Dent Educ 1985; 49(3):179–81.[Medline]
- Clark MS, Fryer GE Jr. A nine-year follow-up survey of medical emergency education in dental schools. J Dent Educ 1993; 57(5):363–5.[Medline]
- American Association of Dental Schools. Report on the fifty-fourth House of Delegates session. J Dent Educ 1977; 41(7):403–4.
- Fast TB, Graham W. Curricular guidelines for management of medical emergency in dental education. J Dent Educ 1981; 45(6):379–81.[Medline]
- Bricker S, Drinnan A, Falace D. Curriculum guidelines for the management of medical emergencies in dental education. J Dent Educ 1990; 54(6):337–8.[Medline]
- Commission on Dental Accreditation, American Dental Association. Accreditation standards for dental education programs. Chicago: American Dental Association, 2006.
- Fast TB, Martin MD, Ellis T. Emergency preparedness: a survey of dental practitioners. J Am Dent Assoc 1986; 112(4):499–501.[Abstract]
- Malamed SF. Medical emergencies in the dental office. 5th ed. St. Louis: Mosby, 2000: 3–5,39–41.
- Lidocaine HCl 2% and Epinephrine 1:100,000 pamphlet: injections for local anesthesia in dentistry. Marketed by Eastman Kodak Company, Dental Products Mfd. by Abbott Laboratories, North Chicago, IL 60064, USA. September 1999.
- Weaver RG, Haden NK, Valachovic RW. Annual ADEA survey of dental school seniors: 2003 graduating class. J Dent Educ 2004; 68(9):1004–27.[Free Full Text]
Top
Abstract
Methods
