The making of the Dental Session

an exercise in creative CME

https://amicnow.org/273

Background:

A major challenge as we approached our 14th Armenian Medical World Congress is to translate the materials discussed into real changes in Armenia.  A major focus of these congresses has been to assist the Ministry of health in developing health policy.  A major criticism has been that we lose momentum during the two-year intervals between these congresses and policy does not change.  

Another criticism is that specialty discussions are given to an audience with diverse backgrounds.  Thus, a discussion of new developments in GI or cardiology will have limited impact on the practice of psychologists, dentists, pharmacist, otolaryngologists or even primary care providers.

The Mission Statement of the 14th Congress describes collaboration and cooperation.  This is highlighted in other discussions of educational goals for this Congress.  (See the discussion of the C-suite)  It is helpful to read the Mission Statement:

The Dental Sessions

The dental sessions are organized by a small group of dentists, an oral surgeon and administrative support.  We are preparing a combination of short specialty presentations (implantology and orthodontics) and a discussion of recommendations for overhauling the dental health program in Armenia.  We have a three-hour window to accomplish a lot.  Our hope is to prepare concise recommendations for the Ministry of health regarding oral health in Armenia while attracting participants with high level discussions of implantology and orthodontics.

There are several major areas where we might impact preventative dental health:

• In-school programs where brushing teeth is taught and reinforced
• In-school and home programs where dental sealants are applied
• Training programs to teach the above to dental students, technicians and even to parents.Increased screening of small children for dental decay
• Public awareness of preventative measures, (despite the commonly held notion that baby teeth are not important because they will fall out)
• Fluoride treatments, either directly applied to teeth, through salt fluoridation, or, less likely, water fluoridation.
• Training programs and an increased role for dental hygienists and dental assistants
• Adoption of electronic dental records to standardize record-keeping
• a "sugar tax"

Government funding is inadequate.  The annual budget for dental screenings and treatments may be exhausted early in the year.  Payments to dentists for preventative care pales in comparison with the income from dental extractions and implants.

The Making of the Dental Sessions

Our core group has met several times online to outlining these issues and solutions.  It has also become obvious that trying to discuss them in any detail during a three-hour time window would go nowhere.  We propose a series of meetings prior to the Congress with online discussion of each of the above points.  Once there is consensus, we can present and discussed a polished version of what would otherwise take many hours.

If successful, this model could be extended to other disciplines such as primary care, nursing, emergency care and others.  Again, refer to the Mission Statement and the discussion of the "C-suite".  The purpose of the Armenian Medical International Committee (AMIC) is to encourage cooperation, collaboration, coordination among the players interested in bettering Armenian health.  The process is simple:

• Identify interested parties
• Identify important issues
• Discuss them as small groups, possibly enlarging the groups with time
• Arrive to Madrid prepared to discuss these important issues with people whom we have gotten to know better in advance of the Congress.

We propose offering continue medical education (CME) and continuous dental education (CDE) credit to the participants of these online discussions prior to the Congress.  The Armenian American Medical Society (AAMS) has kindly agreed to provide these credits.  Requirements for CME and CDE credits are discussed elsewhere.

The following section tells the story as if it as already successfully taken place.  he discussion follows a CME planning format.  Read on if interested:

This concept has some spinoff benefits, hopefully exploring a new teaching modality, increasing attendees' investment in the project, new friendships.  Imagine looking back on a successful program:

This story is told as if it has already happened, as if we are telling people after the Madrid Congress how we created the Dental Session.  We had two hours to discuss important topics, and wanted to attract more attendees with advanced discussion of implantology.

In order to do this, we held meetings before the Madrid Congress to discuss and argue through the points listed below.  We created an RSS (regularly scheduled series) for the sessions and used the Madrid Congress as a summary of the course.  We also proposed continued RSS activity following the Congress.

It consisted of several sessions that were discussed by our planning committee and felt to warrant dedicated time at the Congress.

1. Fluoridation
2. Dental hygienist & assistant training
3. Collaboration, the "C" suite = cooperation, coordination etc.
4. Public health priorities
5. starting young, in the schools, in villages
6. electronic dental records

There was a concurrent track of dental skills training.

1. implantology
2. dental sealants - by Mom
3. Silver diamine fluoride application
4. restorative dentistry
5. maxillofacial repair

Precongress presentations were presented via Zoom meeting or coordinated with ICPD.  The format was developed with post-Congress follow-up activities in mind.  We envisioned continuation of the dental skills training track, making it interdisciplinary and/or addressing varied audiences, such as the dental assistants and students.

 The planning committee (see also https://amicnow.org/267 ) consisted of dental, surgical, public health, foundation, CME and other disciplines.  Financial relationships were disclosed by all planners and faculty.  Outreach to healthcare organizations and individuals was ongoing.

Translation into multiple languages was tried using Google Translate technology.  See also https://amicnow.org/208 .  To overcome limitations of screen size, the "lecture slides" were preloaded to the translation tool in the speaker's preferred language and translated into 3 additional languages.  The main languages translated were Armenian, English, French and Spanish.  Translation to other languages was possible on an individual attendee's personal device.

Pre-Congress ICPD broadcasts had the option to use the translation tool using part of the computer screen, e.g. across the bottom.

The Mission Statement of the Congress reads:

This coincides with the mission of the Armenian Medical International Committee (AMIC), whose mission is to unite and coordinate healthcare associations and service lines worldwide.  See also https://amicnow.org/index.php/about-amic/our-purpose  

The desired physician attributes of cooperation, coordination, communication, a.k.a.  "the C-suite" also included networking, discourse, partnerships as above.

 The format for the event was a moderated round table discussion.  Much of the content was scripted in advance, during the pre-Congress meetings.  Members of the planning committee were selected to present a brief (few minutes) summary of the topic and our conclusions.  If there were varied views on our conclusions, then a different member of the committee would offer a brief (few minutes) summary of the alternate view.  Additional members of the committee could offer brief (10 seconds) comments if desired (possibly also scripted in advance to highlight important learning points).Then we would move to the next topic.  Comments from the audience were limited to 30 seconds.  (Brevity allowed us to cover all topics and keep it entertaining.)

Practice gaps were identified.  They largely focused on the high percentage of diseased and missing teeth among the Armenian children at a young age.  There is an identified need to begin preventive care earlier.

Learning objectives included analysis of data.  A session was offered reviewing crude health data and allowing the participants to calculate rates of disease, which were later compared with official statistics.  The data involving fluoride supplementation was reviewed in view of antifluoride sentiments in Armenia and elsewhere.  See also https://amicnow.org/267

Program analysis included critiques during the planning sessions and feedback from conference attendees during the ICPD calls.   The ultimate measure of success was development of partnerships, (the C-suite) and collaboration among our Congress audience.  In specific terms, success was derived from:

1. new policies adopted at Ministry of Health
2. adoption of a salt-fluoridation program
3. creation of school and community programs to foster oral health (in cooperation with Ministry of Education)
4. Analysis of the number and distribution of oral health professionals in Armenia, and a system of including Diasporan professionals who support them.
5. establishment of oral health as a public health priority.
6. Adoption of a standard electronic dental health record system.

 A wide range of Commendation Criteria were considered. These include the 5 categories of team-based education, addresses skills, demonstrates educational leadership, achives outcomes, addresses public health priorities.