Interprofessional Education

By Christina Boufis

Imagine a patient who has type 2 diabetes and severe periodontitis or an elderly woman who takes many medications for high blood pressure and has other complex health and dental issues. These are just some of the types of patients that Arthur A. Dugoni School of Dentistry students will undoubtedly treat once they graduate.

“The environment of dentistry has changed quite a bit in the last 10 years,” says Dr. Paul Subar, associate professor in the Department of Dental Practice and director of Pacific Dugoni’s Special Care Clinic/Hospital Dentistry program. “Patients are living longer. We have more of a geriatric population, and it’s important that students understand how to work with medical colleagues in order to give the best care possible.”

Today, thanks to collaborative learning or interprofessional educational programs (IPE), Dugoni School of Dentistry dental students are getting the chance to partner with students from other health science schools such as medicine, nursing and pharmacy to learn about, with and from each other.

“Those are the three important words,” says Dr. Darren Cox, associate professor of pathology and medicine in the Department of Biomedical Sciences. “It’s not sitting in a lecture hall learning the same material at the same time; it’s actual patient care where these health professionals bring their perspectives to each patient case.”

According to the World Health Organization, “Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.’’

The idea of interprofessional education has been gaining interest in dentistry and in health care over the last several years, says Dr. Nader Nadershahi ’94, executive associate dean and associate dean for Academic Affairs. In 2011, the Interprofessional Educational Collaborative (IPEC), which includes members from the Association of American Medical Colleges, American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Dental Education Association, Association of Schools and Programs of Public Health and the American Association of Colleges of Pharmacy met, “and came up with a set of core competencies and some suggestions of how the different professions could work together to improve the health of the public through collaboration,” explains Nadershahi.

At the Dugoni School of Dentistry, a task force formed in 2011 to look at IPE and see what it means to the school, he adds. The school established an IPE committee in 2013, chaired by Cox. “We’re trying to build a structure for IPE that will sustain and grow over the years,” says Nadershahi.

One example of a new collaboration is between the Arthur A. Dugoni School of Dentistry and the University of California, San Francisco School of Medicine. The two schools recently signed a memorandum of understanding for an interprofessional education program that will provide collaborative learning opportunities between fourth-year UCSF medical students and third-year dental students in Pacific Dugoni’s DDS program. The agreement builds upon a collaboration that started in 2013 as a trial learning experience when several UCSF medical students on rotation through the UCSF Department of Family Medicine visited Pacific’s Special Care Clinic in San Francisco.

Patients in the Special Care Clinic have moderate to severe medical, developmental, and psychosocial conditions, explains Subar. “They often need oral sedation or nitrous or even general anesthesia, which we do in the hospital setting.” UCSF fourth-year medical students rotate through the clinic, spending several days at a time, “to see how we deliver oral health care to the medically and developmentally compromised patient.”

Another example of an interprofessional educational practice at the Dugoni School of Dentistry is the collaboration with Thomas J. Long School of Pharmacy and Health Sciences in Stockton, where pharmacy students rotate through and work with dental students, explains Nadershahi. “There’s an opportunity for them to learn from each other. Pharmacy students can learn more about dental needs and working with prescriptions for dental patients. And our dental students can learn how the pharmacy students practice and how they can work together more collaboratively.”

So far, the experience has been overwhelmingly positive. “Dental students are excited because they get to talk about dentistry with medical student colleagues and learn about medicine from the medical students themselves. And, medical students receive some dental knowledge. It’s a two-way street in terms of learning, and both sides have really loved it,” says Subar.

In addition, a collaborative partnership with the University of San Francisco, School of Nursing is being implemented at the dental school. “The bachelor’s degree program will coordinate rotations with our students at
Laguna Honda Hospital, while the nurse practitioner program is setting up to have their students rotate through our Pediatric Dentistry Clinic here,” Cox explains. Both of these interprofessional opportunities are win-win opportunities for students. For the nursing students, “The affiliation satisfies the need for interprofessional educational and for more pediatric clinical practice,” he explains. “And, it allows our students to have a nurse practitioner in the clinic where many of the patients also have complex medical needs.”

Interprofessional education is not only a good idea, it’s also mandated by accrediting agencies, including the Commission on Dental Accreditation, says Cox. “It’s part of our accreditation standards now to implement this kind of education model,” he says. But while IPE opportunities are required by the Commission on Dental Accreditation standards, they don’t dictate how they have to be implemented, he adds.

“What we’ve found is that we have implemented something novel to suit our needs,” says Cox. While it might seem that a stand-alone dental school like Pacific Dugoni would have more of a challenge forming partnerships than dental schools that are affiliated with health science schools, but Pacific Dugoni has had the opposite experience. “In fact, at a recent ADEA Dean’s Conference, the Dugoni School of Dentistry was one of three programs highlighted for doing interesting collaborative work,” says Nadershahi. “And this is despite the fact that the school has campuses separated by about 90 miles.”

What’s more, these novel collaborations between schools in the Bay Area benefit not only students, but also dental school professors and everyone involved. “It’s actually a lot of fun getting to work with these other universities and meeting their faculty members,” says Cox. “Those of us involved with them are learning a lot about and from and with these other healthcare professionals, so it’s very advantageous to us, and it’s making me a stronger practitioner here.”

What is the future of IPE at the Dugoni School of Dentistry? “I think we’re at the forefront in being able to offer this kind of interprofessional educational experience to our students,” says Subar. “It’s fun, it’s interesting and it’s really preparing our students for contemporary health care.”

The kind of collaborative partnerships that are formed also fits with Pacific Dugoni’s mission. “Our vision is leading the improvement of health by advancing oral health,” says Nadershahi. “And the more we can work with other professionals to improve the oral health of our patients, the better it is for our patients and students. It is also a way to impact the health of the public overall. So for us, IPE is a direct tie with our vision and different components of our mission here at the dental school.”