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This systematic review culled published competencies in oral health integration into primary care education, searching the literature in the areas of allopathic and osteopathic programs in family and internal medicine and pediatrics and in physician assistant and nurse practitioner programs. The Health Resources and Services Administration's competencies served as the foundational set of competencies for comparative purposes. There were 14 competencies identified as central to the integration of oral health into primary care, which were converted into 7 observable entrustable professional activities (EPAs). The EPAs establish a standard for what a primary care provider should know and be able to do to facilitate adequate oral health for patients without immediate access to a dentist and serve as the framework for oral healthcare integration into primary care curricula.
Primary care providers receive minimal and varied training in oral health. In the US, access to primary care is more prevalent than access to dental care, suggesting that primary care providers can play a strategic role in prevention and early identification of oral diseases and referral to oral health resources. The authors conclude that EPAs can serve as a platform for development of oral health care curricula in primary care training programs.
– Laurie C. Carter, DDS, PhD
This abstract is available on the publisher's site.
Despite advances in oral health care, inequalities in oral health outcomes persist due to problems in access. With proper training, primary care providers can mitigate this inequality by providing oral health education, screening, and referral to advanced dental treatment. Diverging sets of oral health competencies and guidelines have been released or endorsed by multiple primary care disciplines. The aim of this study was to transform multiple sets of competencies into Entrustable Professional Activities (EPAs) for oral health integration into primary care training. A scoping review of the literature between January 2000 and December 2016 was conducted according to PRISMA methodology to identify all existing sets of competencies. The following primary care disciplines were included in the search: allopathic/osteopathic medical schools and residency programs in family medicine, internal medicine, and pediatrics; physician assistant programs; and nurse practitioner programs. Competencies were compared using the Health Resources and Services Administration Integration of Oral Health and Primary Care Practice competencies as the foundational set and translated into EPAs. The resulting EPAs were tested with a reactor panel. The scoping review produced 1,466 references, of which 114 were selected for full text review. Fourteen competencies were identified as being central to the integration of oral health into primary care. These were converted to seven EPAs for oral health integration into primary care and were mapped onto Accreditation Council for Graduate Medical Education residency competency domains as well to the Association of American Medical Colleges EPAs for graduating medical students. The resulting EPAs delineate the essential, observable work required of primary care providers to ensure that oral health is treated as a critical determinant of overall health.