Access to oral health care for vulnerable populations is one of the concerns addressed by the U.S. Health Resources and Services Administration HIV/AIDS Bureau's Community-Based Dental Partnership Program (CBDPP). The program introduces dental students and residents at several dental schools to care for vulnerable patients through didactic and clinical work in community-based dental settings. This study of the dental students and residents in this program answered three questions: 1) What are their HIV knowledge, attitudes, and behaviors? 2) How has participation in the CBDPP impacted their knowledge, attitudes, and behaviors? 3) Has the intervention affected their work placement decisions and attitudes after graduation, particularly with respect to treating people living with HIV and other underserved populations? A total of 305 irst-through fourth-year dental students and irst-and second-year residents at ive dental schools across the United States completed surveys before and after a community-based rotation and following graduation. Response rates at each of the ive schools ranged from 82.4 to 100 percent. The results showed an increase in the participants' knowledge and positive attitudes regarding treatment for patients with HIV and other vulnerable populations post-rotation compared to pre-rotation. Results after graduation found that most respondents were practicing in private settings or in academic institutions as residents but were willing to treat a diverse patient population. These indings support the role of training programs, such as the CBDPP, for expanding the dental workforce to treating vulnerable populations including people living with HIV/AIDS.
BackgroundAbdominal pregnancy is defined as the partial or total insertion of the embryo into the abdominal cavity. It is rare, and can evolve towards the full term if it is not recognized in the early pregnancy. It carries a high risk of maternal-fetal morbidity and mortality.Case presentationWe report a case of a 22 year-old gravida IV, para II with an asymptomatic and undiagnosed abdominal pregnancy presumed full term, in a context of health centers under-equipment. She had attended 5 routine antenatal care, but had not performed any ultrasound scan. She had been transferred from a medical center to the Hospital of Ouahigouya (Burkina Faso) for bowel sub-obstruction and intrauterine fetal death, with failure of labor induction. On admission, the hypothesis of uterine rupture or abdominal pregnancy with antepartum fetal demise was considered. A laparotomy was then performed, where an abdominal pregnancy was discovered, and a dead term baby weighing 3300 g delivered. The placenta which was implanted into the ruptured isthmus of the left fallopian tube was removed by salpingectomy. Postoperative follow-up was uneventful.ConclusionThis case report exposes the necessity for the practitioner to think about the possibility of abdominal pregnancy in his clinical and sonographic practice, irrespective of the gestational age, mainly in contexts where there is under-equipment of the health centers.
While goals and objectives are useful to assess programmatic outcomes, they are not able to evaluate individual trainees' performance and/or corrective actions needed to improve performance. As a result, competency-based evaluation is increasingly being used to assess trainee performance at both the doctoral and postdoctoral levels. However, the translation of broadly stated competency statements into evaluable action statements continues to pose a challenge, especially in nontechnical domains such as the assessment and integration of cultural and sociodemographic variables in the development and execution of treatment plans. This article describes a process used to develop a competency-based framework that includes speciic evaluable action statements to assess the performance of Advanced Education in General Dentistry (AEGD) residents providing dental care services to medically compromised patients in a community-based partnership program.
Columbia University College of Dental Medicine, in partnership with the Harlem United Community AIDS Center, has developed a service-learning (SL) program for use in the training of Advanced Education in General Dentistry (AEGD) residents. This article presents basic tenets of SL, their applicability for dentistry, and our experience implementing SL in care of people living with HIV/AIDS. It proposes that social-behavioral theory, when incorporated into the basic components of SL, can play a useful role in resolving a number of challenges inherent in competency-based training programs. Although the article provides examples of how a particular theory, the Theory of Planned Behavior, might be applied in the SL context, opportunities for the application of other social-behavioral theories potentially exist.
Dr. Kunzel is Associate Professor of Clinical
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