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Br Dent J 2018; 224: 163–168 https://doi.org/10.1038/sj.bdj.2018.44

Struggling to communicate? You're probably not the only one.

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Trepidation, excitement, bewilderment; just a few of the roller coaster of emotions that any undergraduate student would attest to experiencing when seeing patients for the first time. As students face the challenge of putting theory into practice, they can find themselves tackling new and unexpected obstacles, especially in the form of difficult communication situations. The significance of excellent communication by the healthcare professional cannot be understated, particularly with the role we play in public health promotion.

However, as the authors of this article have identified, there appears to be a gross discrepancy in the confidence of students in handling different communication situations. Walker and the co-authors devised a questionnaire to be sent to all students across three year groups in a single dental school to evaluate their confidence at handling different scenarios. The results were as follows:

  • Students became more confident as time went on in most scenarios

  • But there was a slight decrease in confidence over time in relation to discussing human papillomavirus (HPV) and smoking

  • ∼90% of students were confident in communicating about tobacco

  • 75% were confident discussing smoking and cancer

  • 27% felt confident in referring a child due to dental neglect

  • Only 14% of students were confident discussing HPV and its risks in relation to oral health.

With such considerable disparity, it begs the question why? The difference seen in students, for example, when discussing smoking compared to discussing HPV could be explained by the provision of a framework to guide undergraduates in the provision of smoking cessation. If a similar framework concerning HPV and oral health was devised, then it could be used to raise the confidence of students in handling those difficult communication situations.

With 45% of the UK population visiting an NHS dentist in 2016, dentists have a unique ability to mass promote health measures. But to do so, adequate training in complex communication situations, including sensitive and even distressing topics such as neglect, cancer and HPV, must be provided from the very beginning. Consequently, the authors recommend that outcomes pertaining to HPV and its vaccine ought to be included in the undergraduate curriculum especially considering its role as a significant risk factor in developing oral cancer.

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By Arthie Samueli, Dental Student, Barts and The London School of Medicine and Dentistry

Listen to Stephen Hancocks' summary of this research via the BDJ Youtube channel http://bit.ly/BDJYouTube

Why study this topic?

Author Q&A Tom Walker From Bristol Dental School and University Hospital Bristol

I often find myself using communication skills training from medical school in clinical practice, then smile to myself about how often I moaned about it at the time – and how valuable I realise it to be now. During dental school, communication was much less of a focus, indeed there is so much to pack in. The practice of modern dentistry is broad and its impact on general health can be huge: imagine the change in levels of obesity and heart disease if patients just listened to their dentist and reduced smoking, alcohol and sugar for the sake of their dentition.

Did anything surprise you in the results?

We started this study being HPV focused; we didn't expect some of the variations in dealing with smoking cessation or alcohol. This underlines the importance of examining which bit of the scenario is difficult (or more difficult) for students to deal with.

What changes to dental education would you make on the basis of your findings in this study?

Dentists should be empowered, through solid communication skill teaching, to take on some of these complex issues. Dental school should help students by using varied scenarios that cover the breadth of modern dentistry. Currently, HPV is not mentioned as a specific risk factor in dental education guidance from the GDC for head and neck cancer, and the inclusion of this would help dental schools focus on this topic.

Finally, given its importance a standardised national module in dealing with dental neglect must be formulated with some urgency.

In identifying that dental students feel least confident in identifying dental neglect and HPV infection, this study could not be more timely. Dental neglect now forms a more intrinsic consideration in safeguarding decisions. Local authorities are currently coming under increasing pressure to ensure their safeguarding procedures involve the dental team. Dentists need to feel comfortable providing opinions on this to relevant bodies and this study highlights the importance of including this early on in dental training.

Expert view Jonathan Lewney BDJ Open Associate Editor and Academic Clinical Fellow in Dental Public Health, Newcastle Credit: © pressureUA/iStock/Getty Images Plus

Discussing links between HPV infection and oropharyngeal cancer is also becoming increasingly important for the dental team. This study highlights that the confidence to ask the right questions in a clinical setting is far more complex than simply knowing what to ask. Asking the question requires the ability to talk to patients in language they understand and confidence in being able to answer any questions they may have.

Testing dental students' knowledge that oral sex is a risk factor for oropharyngeal cancer is one thing but enabling them to respond to a 16-year-old boy asking if it's ok to give his boyfriend a blow-job is quite another. This would be normal in sexual health training but still feels alien in the context of oral health. This study touches on something dental professionals are well aware of; knowledge alone is unlikely to lead to behaviour change. The confidence to start asking these questions is unlikely to come from didactic teaching alone.

The authors conclude that practice scenarios for communications skills should include these more complex issues and this seems an excellent place for dental schools to start. Finally, the authors suggest some key policy changes as enablers for this change and this timely publication may form a useful starting point for discussions around these.