Download International Service Learning and Changes in Cultural

INTERNATIONAL SERVICE LEARNING
AND CHANGES IN CULTURAL
COMPETENCE IN DENTAL STUDENTS
EA MARTINEZ-MIER, T CARLSON, AE SOTOROJAS, KM YODER, MJ WILLIAMS, JA
HATCHER
Indiana University School of Dentistry, IU Center for
Health Policy, IUPUI Center for Service and Learning
IUSD INTERNATIONAL
SERVICE-LEARNING PROGRAMS
Programs that aim at connecting meaningful
community service experiences with academic
learning, personal growth, and civic
responsibility
WHERE DO THE IUSD PROGRAMS GO?
IUSD SERVICE-LEARNING PROGRAMS
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As part of the Comprehensive Care/Patient Management
& Rounds course (T840/850 ), fourth year dental students
provide clinical treatment of patients applying the
knowledge and skills developed in earlier dental sciences
and clinical sciences courses.
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Additionally, students are exposed, through intramural classes,
to topics of interest to them which they pursue in greater
depth. The International Service-Learning (ISL) course is one
of these intramural classes (T840/850 – E 292).
Service learning is integrated into curriculum which
provides structured time for reflection, enhances teaching
and fosters civic responsibility
IUSD SERVICE-LEARNING PROGRAMS
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This international service-learning course has been
designed to provide:
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Background information on disparities in health care access
and outcomes and recent efforts at eliminating these
disparities
Information on core cultural issues relating to authority,
physical contact communication styles, gender, sexuality and
family that have potential for cross cultural misunderstanding;
and, on attitudes that are fundamental to successful crosscultural encounters: empathy, curiosity and respect
A set of practical methods to employ in cross-cultural
encounters such as how to elicit patient information and
negotiate within a patient
A set of practical methods adapt triage and treatment planning
skills to meet community needs and clinical setting
A “hands on”, interactive, international service-learning (ISL)
experience
WHAT DO STUDENTS DO?
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Register for a semester long class
Attend preparatory sessions
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Participate in “hands on”, interactive international service-learning
experience where they provide dental services (in collaboration with
community members) that include:
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Multidisciplinary lecture sessions
Case studies
Small group discussions
Review of literature
Prepare assignments
Fill a pre and post participation survey to asses progress towards
achieving competencies and meeting class objectives
Education and dental screenings
Fluoride treatments
Sealants and prophylaxis
Restorations
Extractions
Participate in reflection sessions
Evaluate their participation and the program
RESEARCH QUESTION

This study aimed at determining if participation
in an ISL experience allowed dental students at
IUSD to progress towards achieving American
Dental Association (ADA) and IUSD established
competencies.
BACKGROUND
 Competencies
are outlined by the ADA
Accreditation Standards for Dental
Education Programs and the IUSD’s
Competencies for the Dental Graduate
and Standards of Care.
HEALTH PROFESSIONS COMPETENCIES
American Dental Association and IUSD
targeted competencies

Managing a diverse patient
population
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Having the interpersonal and
communication skills to function
successfully in a multicultural work
environment
THEORETICAL FRAMEWORK

A model that best fitted the research question
was identified and a modification of validated
questionnaires was used to assess students’
progress towards competencies.
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We based our approach on Cross’s Cultural
Competency Continuum Model. The model uses a
continuum to assess cultural competency.
RESEARCH DESIGN
Students who participated in an ISL experience
were invited to participate in the study which
also included two control groups.
 The positive control group consisted of students
who had participated in a local service learning
program, and the negative control group
consisted of students who had not had similar
experiences.
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RESEARCH DESIGN
The rationale for this approach was to compare if
both the international and the service learning
components of the experience had an effect when
compared to local or no experiences.
 Our working hypothesis was that students who
participate in ISL experiences progressed faster
towards achievement competency in
communication and cultural professionalism
skills than those who don’t participate in such
experiences.
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MATERIALS AND METHODS
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The study assessed the impact of participation in ISL on
three domains:
knowledge of the impact of values and belief systems on
health case access and utilization
knowledge of cultural competency relates to health care
quality
cross-cultural communication
MATERIALS AND METHODS
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For the values and belief systems domain, questions were
included from a subscale from an instrument modified by
Crosson et al. and developed by Dobbie et al. The Health
Beliefs Attitudes Survey (HBAS) were used.
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This subscale concerns students' knowledge of the values and
belief systems of diverse cultural groups and their impact on
health care access and utilization
MATERIALS AND METHODS
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For the Cross Cultural Communication domain, questions
from a subscale from a self assessment tool Cultural
Competence Health Practitioner Assessment (CCPHA)
developed by the National Center for Cultural Competence
were used.
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The subscale explores capacity for cross-cultural communication,
utilization of different modes of communication, and the provision
of interpretation/translation services.
MATERIALS AND METHODS
To assess the reliability of the HBAS and
CCPHA, we computed Cronbach’s alphas for
students’ survey responses both before and after
the intervention.
 Only those subscales that had alphas > 0.80 were
included in the analysis.
 Before and after participation responses were
compared using ANOVA.
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RESULTS
180 students answered pre
and post experience
questionnaires.
 67 in the ISL group,
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58 in the Seal Indiana
(SI) group and,
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55 in the Negative
Control (NS) group.
RESULTS
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After the experience, a significant difference was
found for group membership on the HBAS scale,
with the ISL group having the highest Cultural
Competency, followed by the NS group and the SI
group
RESULTS
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There was a significant difference in the scores for
pre (mean = 2.37, SD = 0.44) and post-test (mean
= 2.52, SD = 0.47), p < 0.001, indicating that
cultural competency increased between pre and
post for the ISL group.
IUSD SERVICE-LEARNING PROGRAMS
REFLECTION
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“…..I believe a major intent of this program is to
provide students (and faculty) with an
experience that brings to life the reality
from which many of our Hispanic patients
come from. After traveling in the back of pickup trucks to small villages in the mountains of
Mexico, hours away from the nearest health
clinic or hospital, I have a much better
understanding of the background of the people,
their struggles as well as their impressive
need….”
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Student Participant, 2004
IUSD SERVICE-LEARNING PROGRAMS
REFLECTION
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“…..I have learned so much in this program!!!
I was so surprised to see how different children
behave in the villages. The way they talk to their
parents and grandparents, the respect, the
obedience, the silence. I even started to pick up
on the non-verbal ques. No wonder we cannot get
our oral health education messages across. We
expect them to behave like American children
when many of our expectations require behaviors
that are not acceptable in their culture.”
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Student Participant, 2009
INTERPRETATION OF FINDINGS
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Participation in ISL experiences in this sample of
students appears to have increased their
knowledge of the impact of values and beliefs on
access to care and facilitated culturally
appropriate clinical decision making.
RELEVANCE
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This study provides evidence supporting the
impact of service learning in advancing specific
discipline based competencies.
CLINICS
CLINICS
OUR PARTNERS IN CRIME
Dr. Steven B. Blanchard
Dr. Lawrence P. Garetto
Dr. Amul H. Singh
Dr. Armando E. Soto-Rojas
Dr. Karen M. Yoder
Dr. Andrea Ferreira Zandona
QUESTIONS?