Creating a Model Oral Health Curricula for Medical Schools and Pediatric Residencies

Background: Oral health (OH) is a major health issue in the US; it affects both medical outcomes (e.g., diabetes control) as well as personal and social outcomes (e.g., self-esteem and school attendance). Furthermore, oral disease is significantly affected by health inequity, an issue that has become very important in health care. Yet, medical schools, pediatric clerkships, and pediatric residency programs are lagging in teaching OH. National oral health core competencies and Entrustable Professional Activities (EPAs) are established, however they are not part of medical school or residency review standards.

Methods: We surveyed more than 900 medicals schools and primary care training programs in the US (40% of all programs) and conducted in-depth interviews with 30+ ‘best practice’ programs. We evaluated outcomes of our own medical school’s “spiral” oral health curriculum collating data from students test scores and learner feedback for courses that contain oral health content.

Results: Eighty-three percent of pediatric residencies are providing fluoride varnish in clinics however only 26% of residency directors were satisfied with their graduating residents’ level of oral health competence.
Programs with model OH curricula are created with minimal funding; champions are key to sustained success and schools and residencies with robust oral health curricula tend to maximize local and national existing resources. At our medical school 18 of the 26 courses/sub-courses in the pre-clinical years have an oral health component with students rating the subject matter high (>4 out 5) and scoring 80% or greater on written or practical tests. Clinical year offerings include oral health in Aquifer cases in the pediatric clerkship, urgent oral health concepts in emergency medicine, an oral health day, and an oral health elective.

Conclusion: Oral health teaching is important for all medical learners since more than 50% of patients do not visit the dentist annually but often do see their medical provider. More oral health is needed in medical schools and pediatric residencies. Model programs require champions, avoiding reinventing the wheel, and small amounts of funding only. Our curriculum at UMass Medical School can act as an example for other schools to emulate.