P013: Emergency medicine in dental practice: shaping an educational curriculum

Abstract

Introduction: There is increasing public demand for dentists and their professional regulators to mitigate medical risk to patients in private dental clinics – especially those that offer procedural sedation. Recent high-profile adverse events reported in the media suggest an urgent need to address this issue. However, there is a paucity of knowledge in the literature regarding how best to do so. We aim to explore opportunities for multidisciplinary emergency medical training of dentists, and to offer an informed perspective to assist with the preliminary development of a structured educational program. Methods: We employ Gioia Methodology, an established standard for inductive qualitative research and thematic analysis. Interviewees were recruited via email and selected to ensure a broad and knowledgeable perspective. We conducted individual semi-structured 1-hour interviews of 6 dentists, 4 medical anesthesiologists, 3 emergency physicians, and 1 oral and maxillofacial surgeon. Several interviewees had leadership roles in Canadian dental regulatory agencies and educational institutions. Data from these interviews was contemporaneously analyzed and organized into “first-order concepts”, “second-order themes” and “aggregate dimensions.” Results: Our findings demonstrated 12 first-order concepts. Dentists require "leadership from professional regulators", and "accreditation by recognized training institutions" to "ensure competence in initial emergency medical care of patients". "Customized training programs" led by "multidisciplinary instructors" – including emergency physicians – should ensure "pre-operative medical risk assessment", "appropriate intra-operative patient monitoring", and "the ability to recognize common medical emergencies". Emergency medical skills training should focus upon "teamwork within the office", "early activation of EMS", “ABC skills", and the administration of "emergency medications". Conclusion: Dentists require a very broad skillset to safely manage patients in their practice, especially when procedural sedation is required. Our aggregate dimensions provide an overview of our recommendations: we suggest that dentists must work with their regulators and educators to "build upon an existing culture of patient safety" by fostering "competence in the prevention, recognition and initial management of medical emergencies" in the dental practice setting.