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Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 272-275

Interprofessional education: Need and implications for dentistry in India


Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India

Date of Submission12-Apr-2019
Date of Decision16-May-2019
Date of Acceptance30-Jul-2019
Date of Web Publication2-May-2020

Correspondence Address:
Dr. Priyanka Niranjane
Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Sawangi (M), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_70_19

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  Abstract 


Interprofessional education (IPE) is a step toward providing high-quality patient care by producing collaborative and ready to practice health-care professionals. The oral health care needs of the 21st century including increased awareness of oral-systemic connections, an aging population, the shift of the burden of illness from acute to chronic care, and lack of access to basic oral care have made it imperative for health-care professionals including dentists to work in interprofessional teams. This article briefly discusses the historical background and the advancement of IPE in dentistry. It also describes the burden of oral health care in India and the need for IPE and collaborative care in dentistry in India. The article also highlights the barriers/challenges and recommendations for the implementation of IPE in dentistry in India.

Keywords: Dentistry, India, interprofessional education


How to cite this article:
Niranjane P, Diagavane P, Shelke S. Interprofessional education: Need and implications for dentistry in India. J Datta Meghe Inst Med Sci Univ 2019;14:272-5

How to cite this URL:
Niranjane P, Diagavane P, Shelke S. Interprofessional education: Need and implications for dentistry in India. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 May 28];14:272-5. Available from: http://www.journaldmims.com/text.asp?2019/14/3/272/283597




  Introduction Top


“It is no longer enough for health workers to be professional. In the current global climate, health workers also need to be interprofessional.“[1]

Improving the quality of health-care delivery services is the goal of every health profession education. Evidences indicate that if students from various professions learn and practice together, they work better in patient care and delivery of healthcare services.[2]

Interprofessional education (also known “IPE“) is defined as occasions “when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes (WHO, 2010).“[1] The proposition “with, from and about” are key to the learning experience. All the three must be present for IPE to take place, which means that merely bringing students of different professional groups into the same classroom is not enough if the learning is not interactive. Often, health professions education is implemented in silos. Health professions schools prepare students to practice in their own disciplines, minimizing collaboration and teamwork between professions.[3] The aim of IPE is to provide students and practitioners with opportunities to learn together to develop the attributes and skills required to work in an effective collaborative manner. 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.


  Historical Background Top


In 1995, the Institute of Medicine (IOM) in its landmark publication “Dental Education at the Crossroads,” adopted eight strategic and policy principles that were intended to guide the development of dental education, research, and practice to better prepare graduates to improve oral health care.[4] The first of these principles was “Oral health is an integral part of total health, and oral health care is an integral part of comprehensive health care, including primary care.” The committee specifically stated that dentistry must become more closely integrated with medicine in the members’ respective educational programs and in the health-care system.[4]

  • In 1996, Tope conducted a feasibility study into integrated interdisciplinary learning for health professionals and found no IPE involving any dental professional[5] Barr (1998) compared dentistry with other health-care professions and found that dentistry appears to have little involvement in IPE.[6] In 2001, physicians, pharmacists, nurses, physician assistants, and allied health professionals participated in IOM Health Professions Education Summit. Dentistry had no representation on any level neither in the planning committee nor among attendees at the summit[7]
  • Zwarenstein et al. (2001) conducted a Cochrane review to assess the effectiveness of IPE interventions and reported that no dental studies fulfilled the inclusion criteria for the systematic review process[8]
  • Rafter et al. (2006) found minimal involvement of dental students in IPE. The authors surveyed a convenience sample of leaders of seven academic health centers in the United States and showed that IPE was not a high priority and not likely to be integrated into already crowded curricula[9]
  • Rafteret al. reported on the results of a follow-up Cochrane review on IPE. Six studies who met the inclusion criteria showed positive results of IPE in areas including patient satisfaction and collaborative team behavior. Unfortunately, dentistry was not studied in any of the investigations[10]
  • Wilder et al., in the article “call to arms,” the authors suggested that academic dentistry must take the lead in initiating and demanding IPE if dental students are to be prepared to work in the health-care environment of the 21st century. Dental education has to be reformed to include curricular content and clinical experiences with other members of the health-care team including physicians, nurses, and other care providers[11]
  • Evans et al. stated that the study of IPE within dentistry is in its infancy, but formalized IPE is perceived as an effective strategy to improve interactions among oral health professionals leading to improved patient care[12]
  • In 2011, American Dental Education Association Annual Session study group chaired by Dr. Allan Formicola reviewed the pertinent IPE literature, examined IPE competencies for dental students, surveyed the US and Canadian dental schools to determine the current and planned status of IPE activities, and identified best practices[13]
  • In 2013, Commission on Dental Accreditation stated that “the dental school must show evidence of interaction with other components of the higher education, health care education, and/or health care delivery systems” (Standard 1–9) and that “Graduates must be competent in communicating and collaborating with other members of the health care team to facilitate the provision of health care” (Standard 2–19). Thereafter, 2013 and 2014 saw many other articles/symposiums/and workshops incorporating IPE in dental education, and now, a steady momentum can be seen[14]
  • Based on a report by Palatta et al. in 2015, IPE was not appearing to be an essential part of the education in dental schools, and an emphasis toward incorporating IPE in the curriculum was recommended.[15]



  Need for Interprofessional Education and Collaborative Care in Dentistry Top


Oral health is an integral and essential component of general health and well-being. A growing body of scientific evidence has shed light on the connections between oral health and overall or systemic health. Research suggests that poor oral health may be associated with everything from cardiovascular disease, respiratory disease, and diabetes to adverse pregnancy outcomes (IOM, 2011b; US Department of Health and Human Services, 2000) and behavioral health (Rafter et al. (2006)).[16],[17],[18] Oral diseases have also been linked to bacterial endocarditis, atherosclerosis, chronic obstructive lung diseases, and preterm low birth weight. Periodontal health has a direct link with diabetes. Oral health professionals can play a major role in medical screening and monitoring of chronic diseases, such as diabetes and hypertension. Research has demonstrated that the status of patients’ diabetes and hypertension can affect both their oral and overall health.[19],[20] Thus, the complex health-care needs of today's patients need an interdisciplinary approach to achieve optimal health outcomes.

Dentists are often the first line of defense in the prevention, early detection, and treatment of both oral and systemic diseases and therefore must become more involved in providing screening, diagnosis, and referral services for systemic diseases. An increased emphasis on interdisciplinary cooperation between all members of the health-care team can improve oral and systemic health outcomes. However, interprofessionality requires a paradigm shift since interprofessional practice has unique characteristics in terms of values, codes of conduct, and ways of working. This will be difficult to accomplish if dentists have not been trained to work in interprofessional teams, a process that commences with the incorporation of IPE into the dental education curriculum. A change in culture is necessary to facilitate this goal, and this change in culture must begin with education. Curricular restructuring is a key in achieving the required acquisition of knowledge, skills, and behavior during education and training to meet the health-care needs of the 21st century.


  Does Oral Health Care in Indian Need Interprofessional/collaborative Care? Top


Dental diseases are a significant health burden in India as well as across the globe.

According to a survey, the prevalence of dental caries in children aged 5 years is 50%; 52.5% in 12 year olds; 61.4% in 15 year olds; 79.2% in 35–44 year olds; and 84.7% in 65–74 year olds.[21] Consumption of tobacco products (smoking and smokeless form) has also increased in recent years. Hence, oral precancers and cancers are emerging as a major threat to younger people and are increasing to an alarming proportion in India.[22] Dental caries and periodontal disease remain the two most prevalent dental diseases of the Indian population. The growing incidence of some chronic diseases such as diabetes can further have a negative impact on oral health. In developing countries including India, there is a limited access to oral health-care services resulting in the vast difference in oral health status between urban and rural populations.[17] As per the latest statistics, 70% of the Indian population resides in rural areas where the concentration of dentists is only 10%, while 30% of population resides in urban areas where 90% of dentists are concentrated.[17] Thus, the need of the hour in India is to amalgamate the skills and knowledge of dentists and other allied health professionals to provide optimum oral and general health care to the patient. The IPE and collaborative care model can bridge the medical/dental divide, thus improving patient's access to care and promoting optimal health outcomes.


  Benefits of Interprofessional Education in Indian Oral Health-Care Setup Top


In developing countries like India, oral health care is provided by both the public and private sectors. The public health-care system faces many challenges, including the deployment of health-care professionals and the skill mix of staff across the entire health-care system.[4],[5],[6],[7] Therefore; it becomes increasingly important that the health-care professionals work together as a team. The team approach ensures better utilization of the resources, thereby facilitating an individual to receive a more comprehensive and quality treatment. The team-based practice has been a mantra in health-care delivery for decades; however, little has been done to implement it into patient care delivery. Many a time, medical professionals feel a lacuna in diagnosing the problems associated with the oral cavity. They often ignore the severity associated with the same, and most of the time, the patients are left uninformed about the importance of an oral health examination. Dentists are well trained in diagnosing and treating the diseases and conditions related to the oral cavity. This will lead dentists helping their patients to manage their medical care and physicians in helping patients to better manage their dental care. Thus, an approach toward interprofessional collaboration will not only improve the quality of treatment provided to the patient but also improve the interprofessional communications. Hence, it is imperative that medical and dental fraternity should understand the role of integrated patient care which, in turn, will pave the way for achieving a whole new dimension in attaining higher standards of patient care.


  Challenges in Incorporating Interprofessional Education in Dentistry Top


There are many challenges in developing and adopting IPE in the current dental education scenario in India.

Development of interprofessional education curriculum

Oral health is frequently absent from the curricula outside of dentistry and the allied dental professions.[23] Designing common curricula for IPE for all professions involved is a big challenge which itself requires the collaboration of different professional experts.

Faculty development

Faculty requires training to develop, implement, and facilitate IPE activities.[24]

Lack of administrative support

The deans, heads of department, and administrative leadership should be supportive of IPE.[20] Certification, licensure, and accreditation of IPE across different professions is an aspect that is ignored.

Assessment of interprofessional education competencies

There is a scarcity of valid tools for assessment of IPE core competencies.

Logistic issues related to timing of semesters, academic calendar, and class scheduling are reported to be common barriers for IPE implementation.[25]

Behavioral barriers that relate to stereotypes, resistance to change, and lack of communication between dental schools and other health professional colleges also are commonly cited challenges to interprofessional education and collaboration.[10]


  Recommendations for the Inclusion of Interprofessional Education in Dentistry Top


Restructuring the curriculum by the incorporation of IPE core competencies – the dental curriculum – should be restructured to incorporate team competencies for dentists and allied dental health professionals. IPE experiences in the form of collaboration with medical, nursing, pharmacy, Ayurveda, etc., should be provided to dental students. The introduction of IPE early in the curriculum ideally, course material on IPE should begin as early as the 1st year and continue throughout the curriculum to include appropriate content and competencies.[11]

Faculty needs to be sensitized and trained in various aspects of IPE before taking up the implementation part. Dental schools need to invest in both intra- and interprofessional faculty training to develop a cadre of faculty members prepared to develop IPE coursework.[13]

Addressing professional stereotypes – interprofessional collaboration – in practice starts with IPE. The current educational systems train health-care providers (doctors, nurses, dentists, pharmacists, etc.,) in isolation from one another, and therefore, the understanding and ability to work in a collaborative manner with other health-care professionals does not exist resulting in a poor quality of care and high rate of preventable medical errors. Dental education in India does not prepare dental students to participate in the comprehensive health care of patients. To develop collaborative skills that bring down professional silos, it is imperative to introduce IPE early in the education of health-care professions. When students from dentistry, medicine, dental hygiene, nursing, and pharmacy are trained together, the practice will be more easily transferred into clinical settings and include multidirectional referral and reinforcement of health.

The evaluation of IPE efforts should be built into the planning and implementation of coursework. Assessing outcomes in relation to IPE's ultimate objective, i.e., improved patient care due to a team approach, should be the ultimate goal of the evaluation process.[13] Designing a common schedule and adjusting the timings to bring all learners together across different professions should be worked upon.[27],[28]

Certification, licensure, and accreditation for IPE programs accreditation standards across the dental profession should be revised to provide evidence of IPE in the curricula.


  Conclusion Top


Gordon and Donoff stated, it is essential, that we change the concept that “oral health is connected to systemic health” to the concept that “oral health is integral to overall health,“[25] in agreement with the IOM report.[26] It would be of great benefit to the dental profession for educators and care providers to increase the footprint of dental and oral health care in IPE. Future dentists will have knowledge and skills needed to take up new role and responsibilities and to function as responsible members of the health-care team. By preparing health professional students with basic oral health and interprofessional competencies and by instilling respect for collaboration, health professions programs can make a major contribution to paving the way for a healthier tomorrow.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO Study Group on Interprofessional Education and Collaborative Practice. Framework for Action on Interprofessional Education & Collaborative Practice. Geneva, Switzerland: World Health Organization; 2010. Available from: http://whqlibdoc.who.int/hq/2010/WHO_HRH_ HPN_10.3_eng.pdf. [Last accessed on 2109 May 15].  Back to cited text no. 1
    
2.
Hammick M, Freeth D, Koppel I, Reeves S, Barr H. A best evidence systematic review of interprofessional education: BEME Guide no. 9. Med Teach 2007;29:735-51.  Back to cited text no. 2
    
3.
Angelini DJ. Interdisciplinary and interprofessional education: What are the key issues and considerations for the future? J Perinat Neonatal Nurs 2011;25:175-9.  Back to cited text no. 3
    
4.
Institute of Medicine. Dental Education at the Crossroads: Challenges and Change. Washington, DC: National Academies Press; 1995.  Back to cited text no. 4
    
5.
Tope R. Integrated Interdisciplinary Learning between the Health and Social Care Professions: A Feasibility Study. Avebury, UK: Aldershot; 1996.  Back to cited text no. 5
    
6.
Barr H. Competent to collaborate: Towards a competency-based model for interprofessional education. J Interprof Care 1998;12:181-7.  Back to cited text no. 6
    
7.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.  Back to cited text no. 7
    
8.
Zwarenstein M, Reeves S, Barr H, Hammick M, Koppel I, Atkins J. Interprofessional education: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2001;1:CD002213.  Back to cited text no. 8
    
9.
Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Hammick M, et al. Interprofessional education: Effects on professional practice and health care outcomes Cochrane. Cochrane Database Syst Rev 2008;1:CD002213.  Back to cited text no. 9
    
10.
Rafter ME, Pesun IJ, Herren M, Linfante JC, Mina M, Wu CD, et al. A preliminary survey of interprofessional education. J Dent Educ 2006;70:417-27.  Back to cited text no. 10
    
11.
Wilder RS, O'Donnell JA, Barry JM, Galli DM, Hakim FF, Holyfield LJ, et al. Is dentistry at risk? A case for interprofessional education. J Dent Educ 2008;72:1231-7.  Back to cited text no. 11
    
12.
Evans J, Henderson A, Johnson N. The future of education and training in dental technology: Designing a dental curriculum that facilitates teamwork across the oral health professions. Br Dent J 2010;208:227-30.  Back to cited text no. 12
    
13.
Formicola AJ, Andrieu SC, Buchanan JA, Childs GS, Gibbs M, Inglehart MR, et al. Interprofessional education in U.S. and Canadian dental schools: An ADEA team study group report. J Dent Educ 2012;76:1250-68.  Back to cited text no. 13
    
14.
Commission on Dental Accreditation. Accreditation Standards for Dental Education Programs. Available from: http://www.ada.org/~/media/CODA/Files/predoc.ashx. [Last accessed on 2109 May 15]  Back to cited text no. 14
    
15.
Palatta A, Cook BJ, Anderson EL, Valachovic RW. 20 years beyond the crossroads: The path to interprofessional education at U.S. dental schools. J Dent Educ 2015;79:982-96.  Back to cited text no. 15
    
16.
Dolce MC, Holloman JL, Fauteux N. Oral health: A vehicle to drive interprofessional education. J Interprof Care 2016;30:4-6.  Back to cited text no. 16
    
17.
National Oral Health Policy, India. Prepared by Core Committee, Appointed by the Ministry of Health and Family Welfare, Government of India; 1995. Available from: http://www.aiims.edu/aiims/events/dentalworkshop/nohc-prog.htm. [Last accessed on 2015 Mar 20].  Back to cited text no. 17
    
18.
Field MJ. Dental Education at the Crossroads: Challenges and Change. Washington, DC: National Academy Press; 1995.  Back to cited text no. 18
    
19.
University of Pacific Arthur A. Dugoni School of Dentistry. Pacific Dugoni Partners with UCSF School of Medicine on Interprofessional Education Opportunities. Available from: http://dental.pacific.edu/News_and_Events/News_Archive/Pacific_Dugoni_Partners_with_UCSF_School_of_Medicine_on_Interprofessional_Education_Opportunities.html. [Last accessed on 2109 May 15]  Back to cited text no. 19
    
20.
Hall LW, Zierler BK. Interprofessional education and practice guide no. 1: Developing faculty to effectively facilitate interprofessional education. J Interprof Care 2015;29:3-7.  Back to cited text no. 20
    
21.
Bali RK, Mathur VB, Talwar PP, Chanana HB. National Oral Health Survey and Fluoride Mapping, 2002-2003. India: Dental Council of India; 2004.  Back to cited text no. 21
    
22.
Parkash H, Duggal R, Mathur VP. Final Report and Recommendations, Formulation of Guidelines for Meaningful and Effective Utilization of Available Manpower at Dental Colleges for Primary Prevention of Oro-dental Problems in the Country. New Delhi: A GOI- WHO Collaborative Programme; 2007.  Back to cited text no. 22
    
23.
Hein C, Schönwetter D, Iacopino A. Inclusion of oral-systemic health in predoctoral/undergraduate curricula of pharmacy, nursing, and medical schools around the world: A preliminary study. J Dent Educ 2011;75:1187-99.  Back to cited text no. 23
    
24.
Watkins KD. Faculty development to support interprofessional education in healthcare professions: A realist synthesis. J Interprof Care 2016;30:695-701.  Back to cited text no. 24
    
25.
Valachovic RW. Integrating oral and overall health care--on the road to interprofessional education and practice: Building a foundation for interprofessional education and practice. J Calif Dent Assoc 2014;42:25-7.  Back to cited text no. 25
    
26.
Gordon SC, Donoff RB. Problems and Solutions for Interprofessional Education in North American Dental Schools. Dent Clin North Am 2016;60:811-24.  Back to cited text no. 26
    
27.
Institute of Medicine. Advancing oral Health in America. Washington, DC: The National Academies Press; 2011.  Back to cited text no. 27
    
28.
Mahajan R, Mohammed CA, Sharma M, Gupta P, Singh T. Interprofessional education: An approach to improve healthcare outcomes. Indian Pediatr 2018;55:241-9.  Back to cited text no. 28
    




 

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