Our program was developed as an elective during the pediatric clerkship for third year medical students at Albert Einstein College of Medicine, Bronx, New York. Prior to implementation of this pilot study, all medical students at Albert Einstein College of Medicine were exposed to fifteen minutes of instruction dedicated to oral health through a head and neck physical examination didactic lecture and workshop taught during the second year of medical school. Third year medical students have typically completed the didactic portion of medical school and are in their first year of hands-on clinical training. All students (n = 270) beginning their pediatric clerkship in the academic years of 2019–2020 and 2020–2021 were contacted via email and were offered the opportunity to volunteer for the study. Those that agreed to the study were incentivized to complete the study with a $50 Amazon gift card given at completion of all required activities. The program was approved by the Albert Einstein College of Medicine’s Office of Medical Education (OME) and supported by a Grant for Excellence in Medical Education. The study was reviewed and approved by the Albert Einstein College of Medicine Institutional Review Board (IRB) (#2018–9556).
Prior to initiating the SFL modules and clinical experiences, students completed a pretest via Qualtrics software. The pretest assessed knowledge via 21 multiple choice questions about common oral health diseases, normal dental anatomy, and epidemiology of oral health conditions (Table 1). The questions were adapted from questions supplied in the SFL curriculum implementation toolkit; questions were chosen specifically for their relevance to the intersection of medicine and oral health. In addition to knowledge-based questions, students were given seven questions, assessed via a Likert scale, regarding their familiarity with oral health topics, attitudes, and comfort regarding oral health care, providing oral health care education and guidance, and performing oral examinations on patients. These questions were adapted from validated questionnaires utilized by similar articles that assessed provider attitudes and comfort .
Students completed four core modules of the SFL curriculum online. SFL provides a multi-media, case-based interactive platform that delivers information to the learner, and then immediately provides the learner with the opportunity to apply their clinical knowledge in case-based scenarios. These four modules covered the relationship between oral and systemic health, the basics of child and adult oral health, and acute dental problems. Students were able to complete these modules at any time throughout the clerkship utilizing a self-directed learning model.
In order to provide an active learning component, students were assigned three half-day sessions in pediatric dental clinics at Jacobi Medical Center Department of Dentistry or at the Rose F. Kennedy Center for Excellence in Developmental Disabilities dental clinic. During these clinical sessions, medical students were provided hands-on peer instruction by pediatric dental residents, oral and maxillofacial dental residents, and dental faculty. Clinical skills practiced in these sessions included oral examinations, caries risk assessments, and periodontal disease risk assessments.
At the end of the rotation upon completion of all three half-day sessions and the SFL modules, students were given a posttest, which included the same multiple choice and Likert scale questions as the pretest in order to assess knowledge gain and changes in attitudes and comfort regarding clinical skills.
Differences in outcome measures were analyzed via GraphPad Prism Version 8.2.1 for macOS (GraphPad Software, San Diego, California). Scores on the pretest and posttest assessment were compared using a matched pair student’s t-test, with Cohen’s d analysis to measure effect size. For the Likert scale analysis, positive responses of ‘very’ or ‘somewhat’ were pooled and compared with ‘neutral,’ ‘not at all,’ and ‘not very’ responses, and significance testing via Fisher’s exact test was performed with a P value < 0.05 used to define statistical significance.