Self-directed learning, teamwork, holistic view and oral health

Sammanfattning: The dental program at the Malmö dental school, the so called Malmö-model, is guided by four linked principles: self-directed learning, teamwork, a holistic view of patient care, and oral health (Fig.1). Figure 1. The four guiding principles of problem based learning at TVH, Malmö. Self-assessment ability is a critical competence for healthcare professionals, necessary for the successful adaptation to the modern life-long learning environment. Educational research seems to point out two critical factors for the development of such skills, continuous practice of self-assessment (1) and constructive feedback (2). The first study (3) presented in this publication assessed students’ self-assessment ability by means of the Interactive Examination in a cohort of senior dental students, who had gone through an identical assessment procedure during their second year of studies (4). The results indicated that self-assessment ability was not directly relevant to subject knowledge. Upon graduation, there were a number of students (10%) with significant self-assessment difficulties. Early detection of students with weak self-assessment abilities appears possible to achieve. The aim of the second study, concerning teamwork and holistic view (5), was to investigate if highlighting teamwork between dental and dental hygienist students could improve the students’ holistic view on patients, as well as their knowledge of, and insight into, each other's future professions. Thus, this project showed that by initiating teamwork between dental and dental hygienist students, it was possible to increase students’ knowledge on dental hygienists competence, develop students’ perceived holistic view on patients, and prepare students for teamwork. The third study explored findings clinicians use when diagnosing chronic periodontitis. A questionnaire was distributed to students, dental teachers and clinical supervisors in the Public Dental Services. Within all categories of clinicians, the majority of the clinicians used deepened pocket, bone loss on x-rays, and bleeding. There were differences in the use of findings between the categories of clinicians. None of the supervisors used attachment loss as a finding, while 13% to 27% of the other categories of clinicians used this finding. A higher frequency of dental hygienist students used plaque, calculus and pus, compared to the other categories. Dental hygienist students used more findings as compared to the other categories of clinicians. Fifty-eight of the 76 clinicians used each finding solitarily, i.e. one at a time, and not in combination to diagnose chronic periodontitis. However, about a third of the dental students and the supervisors only used findings either from the soft tissue inflammation subgroup or the loss of supporting tissue subgroup. With the exception of the dental teachers, the majority of clinicians within each category used irrelevant findings. The third study (6) gave valuable information when designing the fourth study (7). The In the fourth study, a questionnaire was distributed to 2,440 professional clinicians, i.e. dentists and dental hygienists in public and private activity, and dental students at the Dental school in Malmö. The results showed that two groups, representing dentists and dental hygienists delivering basic periodontal care in Sweden, were to a significant degree not sharing the knowledge basis for diagnosis and treatment planning. This may result in a less optimal utilization of resources in Swedish dentistry. The delivery of basic periodontal care was not in line with the severity of disease and too much attention was paid to the needs of relatively healthy persons. To change this pattern, the incentives in, and structure of, the national assurance system need to be adapted in order to stimulate a better inter-collegial cooperation between dentists and dental hygienists in basic periodontal care.