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Dentistry in Health Services


Dr. Juan BernalProfessor of the Department of Social Odontology at Cayetano Heredia Peruvian University; Head, Oral Health Department at Cayetano Heredia National Hospital, Lima, Peru

Introduction

For the development of sound teaching related to dental services, the relationships and joint activities of academic and health services programs will have to be carefully planned. In this integration there are two "partners": academic and health services professionals (in the Local Health System - SILOS). Some aspects of both parts, their interaction, and implications for successful integration of teaching and services will be reviewed.

Teaching Expectations

Teachers and students usually have perceptions and expectations concerning the integration of academic activities with health services, which are usually different from those of the health services personnel. From the standpoint of the academia, the expectations might include:

· Expansion of opportunities for academic work in clinical health services environments, usually public (Ministries of Health and Social Security, Education, etc.). Due to inherent differences as compared with dental school clinics, this implies the growth of service-based clinical environments for teaching and an extended urban and geographical influence of school activities.

· Opportunities to develop in-service learning experiences in health assistance, according to the priority schemes of respective health services programs.

· Exposure to an increase in quantity, quality and complexity of cases. In health services, the demand for public assistance is great and diversified: simple vs. complicated cases, requiring prevention and/or recovery; oral vs. general health care; prevalent vs. nonprevalent disease priorities; emergency vs. scheduled care; individual vs. community assistance;

· Exposure to realities of community health service. Limitations in equipment or facilities are often encountered in public services, thereby providing a range of work conditions beyond the exposures offered by university clinics. Experiences with cultural and socioeconomic variables are also included.

· Opportunity for interdisciplinary follow-up regarding general and oral health problems - participation in interdisciplinary prevention/recovery health programs which are potentially inter-institutional and intersectorial.

· Expansion of sites for clinical, epidemiological, and operations research, closely tied to possibilities of immediate application of the results in health services programs.

Health Services Expectations

Coordination between university faculty and students and health services professionals also generates expectations among the latter. For example, a university presence in various health services settings might mean the following:

· Support for improving the range of services

· Support for improving quality in service assistance. It is implicit that university specialists working in health services will enhance capabilities for service-based case resolution, which increases clinical scope without required support from referral centers

· Increase in the prestige of health services, through operational ties to an academic institution

· Better continuing education opportunities for health services professionals, both on-site and in the university setting

· Opportunities for increased interaction between health services professionals and university faculty. This should provide opportunities for health service professionals to develop part-time teaching positions in the university without sacrificing employment security in health service organizations.

Critical Aspects

In addition to the positive expectations from both sides, there is always a risk of complications that may arise from the increased interaction between university and health services personnel. These might include professional prejudice or negativism among university faculty toward health service personnel. Moreover, some academic professionals might have limited experience or capabilities for working with inter- institutional staff, resulting in a reduced willingness to work as part of a teaching/care team.

On the other side, the presence of university faculty and students in health services settings might be considered additional work for employed professionals in terms of increased time demands in coordination, supervision, meetings, reports, and problem-solving.

Clearly, a range of outcomes is possible when attempting to increase professional interaction between academic faculty and students and health services staff. Consequently, it is imperative to emphasize positive aspects of the teaching experience in health service environments so as to maximize the beneficial features of integration and facilitate success of the project.

Recommendations

To ensure the development of a sound teaching-service integration program, we suggest the following recommendations:

· Through consideration by both universities and health services of the advantages of joint programs (e.g. economic advantages, training opportunities, research participation, etc.)

·Formalized inter-institutional agreements between universities and the Ministry of Health;

·Establishment of coordinating committees with representation from both university and health service sectors;

·Establishment of mechanisms between service and teaching programs to facilitate coordination in development, operation, supervision, and evaluation of joint projects;

·Equity among representatives of academia and health services, especially at program operations and supervision levels;

·Cooperation in program coordination and problem-solving;

·The university should study ways of providing incentives to the health services personnel that participates in the project, such as specific training, academic recognition and, whenever possible, complementary income;

·Regular communications with the leadership of university and health services organizations to ensure continued political support for the programs;

·Communications with the service population concerning program objectives and activities, including invitations for participation in program development and decision-making as appropriate.


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