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Dental Students Delight in Interprofessional Care, Education

April 13, 2017

In Tagalog/Filipino, “Mabuhay” is a greeting or celebratory toast that means “long live” or “cheers.” It’s also like a verbal high-five or fist-pump.

The term certainly is fitting at the student-run Mabuhay Health Center in San Francisco’s South of Market neighborhood, where most of the patients are elderly Filipinos striving for a long and hearty life.

Mabuhay Health Center logoIt’s appropriate, too, for UCSF dental students, heartened by closer collaborations with students and health care professionals from different fields. They cheer a new model of interprofessional patient care and education that puts dental students in the frontline of care alongside medical, pharmacy and nursing students.

And the patients at the Mabuhay Health Center benefit from comprehensive checkups that consider oral health with various medical assessments.

The Mabuhay Health Center was established in 2008 by UCSF students to offer free, culturally sensitive health care in a neighborhood with a largely immigrant, mostly Filipino, population. It offers a monthly clinic with physical examinations, screenings, vaccinations, medication counseling and health education. UCSF students from all the professional schools and community health coaches volunteer care. Medical, pharmacy, nursing and dental professionals – or preceptors – oversee the students’ screenings and health care management.

“Until recently, dental screenings, evaluations and management at the clinic were conducted separately, and there was little to no communication between dentals students and those from the other professions,” said Sheila Brear, associate dean for academic affairs in the UCSF School of Dentistry.

She and the preceptors saw this as a barrier to interprofessional practice and education. So, in February, they developed a pilot program that included dental students into the intake, screening and examination process. The new approach also added value to the patient experience.

The pilot placed dental students into the important “huddles” — discussions between health professionals and students. In initial screenings, questions added to those about other medical complaints and habits included, “Do you have any pain in your mouth, head or neck?” “Do you have any problems chewing your food?” “Are you able to brush/floss your teeth?”

At the clinic, students and preceptors performed initial screenings of patients. And during the first huddle, a small team of professional students — one representing each health discipline — discussed a general approach to acute or chronic health issues for each patient. A larger group of professional students and preceptors was available to help.

After initial huddles, students examined patients, aided with recommendations from the larger group. Later, students returned to a post-patient huddle to present histories and clinical findings to the preceptors and the large group, where assessments plans were finalized.

“The immediate feedback from medical and pharmacy students about this new approach was overwhelmingly positive,” said Dr. Brear. “Non-dental students learned about and then directly observed oral examinations, which included screenings for oral cancer. Dental, pharmacy, medical and nursing students engaged in vigorous discussions around important topics such as perioperative medication management and potential for uncontrolled chronic diseases to post-operative outcomes.

“Importantly, the patients benefited from important counseling and recommendations from dental students and dentists,” said Dr. Brear.

First- and second-year dental students participating in the clinic were enthusiastic about the interprofessional approach to patient care. “We were not limited to analyzing just the patient’s oral health,” said second-year dental student Maritess Aristorenas. “For example, a patient was diagnosed with vertigo, and we wanted to know what factors could trigger her vertigo. All the students from the different schools contributed ideas such as orthostatic hypotension, stress, or other possibilities.

“It was wonderful to see all of us working as a team – no divisions, no hierarchy,” said Aristorenas. “I was really excited that I was able to apply what I learned in biomedical science class for this case. At the end of the event, we all discussed how we felt about working together, and we all agreed that this volunteer event was the most effective interprofessional opportunity we’ve encountered.

“I was surprised at how UCSF has prepared us dental students to recall certain conditions or pharmacologic agents that real patients actually have or take,” Aristorenas continued. “I told my friends that I truly felt like I was a doctor. It was truly a rewarding experience, and I cannot wait to do it again.”

“After this clinic session, I felt inspired to keep up with my dental training as well as review what I have learned throughout my first two years in dental school,” said second-year dental student Noel De Leon. “In future clinic sessions, I hope to be able to contribute more during our team huddles, not only for the patient’s oral health but to share my knowledge with the students of the other health disciplines.”

“Students both implicitly and explicitly learned the importance of professional humility and respect,” said preceptor Christopher Bautista, MD, UCSF assistant professor of medicine. “They learned skills in interprofessional communication. Additionally, faculty also found unique opportunities for academic collaboration and teaching. The integration of dental students and dentists to the team at Mabuhay clinic represented exactly the educational, interprofessional, community and patient care missions of our academic institution and the clinic.

“As a result of this rich experience, and to provide the best patient care, an interprofessional screening tool and an outcomes of care screening tool will be developed and piloted in this clinic,” he added.

And that deserves a hearty “Mabuhay” and fist-pump.

Andy Evangelista contributed to this story.