AAMC Reporter: May 2008

Reports Recommend More Oral Health Education in Medical Schools

The nation's future doctors and dentists should work together more closely and receive better training on the connections between oral health and overall well-being, according to two new reports from an expert panel.

"Contemporary Issues in Medicine: Oral Health Education" provides information and guidelines on what medical students should know about where oral health and overall health intersect. It is the latest report from the AAMC's Medical School Objectives Project (MSOP) series, an ongoing initiative designed to develop consensus around appropriate medical student learning objectives. A parallel report, titled "Curriculum and Clinical Training for Physicians and Dentists," was published earlier this year and provides the dental education community with guidelines and information similar to those in the MSOP report. Both reports were prepared by a group of medical and dental educators convened jointly by the AAMC and the American Dental Education Association (ADEA).

"There is recognition in both dentistry and medicine that oral health directly impacts systemic health," said AAMC Medical Education Director Alexis L. Ruffin. "We hope these two reports prompt each profession's academic community to better address the role that oral health education ultimately plays in patient care quality."

An increasing body of knowledge shows an unbreakable link between these two fields. According to "Oral Health in America," a 2000 report from the U.S. Surgeon General, periodontal disease is associated with diabetes, cardiovascular disease, stroke, and adverse pregnancy outcomes. Oral symptoms may be the first indicators of leukemia and HIV/AIDS. Oral health disparities are profound— more than 108 million people do not have dental The nation's future doctors and dentists should work together more closely and receive better training on the connections between oral health and overall well-being, according to two new reports from an expert panel.

"Contemporary Issues in Medicine: Oral Health Education" provides information and guidelines on what medical students should know about where oral health and overall health intersect. It is the latest report from the AAMC's Medical School Objectives Project (MSOP) series, an ongoing initiative designed to develop consensus around appropriate medical student learning objectives. A parallel report, titled "Curriculum and Clinical Training for Physicians and Dentists," was published earlier this year and provides the dental education community with guidelines and information similar to those in the MSOP report. Both reports were prepared by a group of medical and dental educators convened jointly by the AAMC and the American Dental Education Association (ADEA).

"There is recognition in both dentistry and medicine that oral health directly impacts systemic health," said AAMC Medical Education Director Alexis L. Ruffin. "We hope these two reports prompt each profession's academic community to better address the role that oral health education ultimately plays in patient care quality."

An increasing body of knowledge shows an unbreakable link between these two fields. According to "Oral Health in America," a 2000 report from the U.S. Surgeon General, periodontal disease is associated with diabetes, cardiovascular disease, stroke, and adverse pregnancy outcomes.Oral symptoms may be the first indicators of leukemia and HIV/AIDS.Oral health disparities are profound— more than 108million people do not have dental health insurance, or more than double the number of individuals lacking medical insurance. These disparities can be aggravated by physicians' lack of oral health awareness.

"Bringing these disciplines closer together will let patients receive the most optimal care at both the physician's and dentist's office," said panel co-chair Charles N. Bertalomi, D.D.S., D.Med. Sc., ADEA president and Herman Robert Fox dean of the New York University College of Dentistry. "It's harder to argue for keeping the two fields apart."

Still, the disciplines have historically evolved along separate tracks.

"Oral health has been allocated to dentistry, in physicians' minds," said panel co-chair Wendy Mouradian, M.D., M.S., director of the Regional Initiatives in Dental Education (RIDE) at the University of Washington School of Dentistry. "As physicians, we are positioned to do oral screenings and promote good oral health care, but we don't have the proper training."

The reports call for medical and dental students to understand how oral health and overall health affect each other in various settings. Scientific disciplines like microbiology, pathology, and nutrition should include oral health information, the reports state. Students should be familiar with certain clinical events, such as oral and pharyngeal cancers, and orally based indicators of sexually transmitted diseases and eating disorders, among other conditions. Performing a head-and-neck examination and obtaining medical and dental health histories are important skill sets for students in both disciplines, the reports state.

To most effectively convey these principles to learners, the reports recommend a "spiral curriculum" in which the concepts are introduced in basic science training and then re-emphasized during later clinical experiences. In 2005, the University of Washington School of Medicine collaborated with the university's dental school to create such a curriculum. The curriculum incorporates five oral health themes—public health, dental caries (an infectious disease that damages tooth structure), periodontal disease, oral cancer, and oral-systemic interactions—into a four-year program.

The schools of medicine and dental medicine at Case Western Reserve University have taken this approach a step further. In 2008, the university began offering a combined M.D./D.M.D. degree program. Students will train in both medicine and dentistry during the five-year integrated curriculum.

Another goal of the reports is to identify and promote competency domains important for all health professions students. These items, largely reinforcing the Institute of Medicine's 2003 report titled "Health Professions Education: A Bridge to Quality," include providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement approaches, and using informatics. Shared attitudes and knowledge, according to the reports, can facilitate more effective interprofessional collaboration.

"Multidisciplinary treatment is needed for complex cases," said Ronald P. Strauss, D.M.D., Ph.D., a dental professor at the University of North Carolina at Chapel Hill School of Dentistry. "When professionals can share expertise effectively, new ideas come into consideration that were not on the table before."

For example, Strauss said, the North Carolina dentistry school's craniofacial center relies on groups of surgeons, dentists, social workers, and speech pathologists to provide team-oriented care for patients with congenital malformations.

To help students master these cross-disciplinary domains, the reports suggest that they participate in service-based learning experiences in underserved areas. Many dental schools offer this type of program.At the University of Washington's RIDE program,medical students, dental students, and dental hygiene students train together for one year in a rural, underserved setting. RIDE will combine extended community clinical rotations with interprofessional education.

Medical and dental education collaboration is continuing in other venues. Recently, the AAMC and ADEA agreed to expand MedEdPORTAL (Providing Online Resources to Advance Learning) to include dental education submissions. MedEdPORTAL is the AAMC's central repository of peer-reviewed teaching resources, graphics, tutorials, and faculty development materials.

The AAMC-ADEA partnership also provides technical support and direction to the Summer Medical and Dental Education Program (SMDEP), an academic enrichment program for college students interested in medical and dental careers. SMDEP is funded by the Robert Wood Johnson Foundation.

—By Elissa Fuchs

Contact Us    © 1995-2008 AAMC    Terms and Conditions    Privacy Statement