A case study on development of a spiral oral health curriculum for medical students

Inadequate oral healthcare remains a critical public health issue in children and adults in the US affecting adverse social, psychological, economic, and health outcomes. Medical clinicians have a clear role in addressing oral health issues and improving outcomes. Oral health guidelines for health profession schools were developed by the Association of American Medical Colleges (AAMC) oral health core competencies, and the newer Center for Integration of Primary Care and Oral Health's (CIPCOH) Entrustable Professional Activities (EPAs). However, the majority of health professional school deans and residency directors in the US report they are not satisfied with the oral health knowledge and skills of their learners at graduation. To address this issue, faculty at the University of Massachusetts Chan Medical School (UMCMS) have worked for the past decade to develop and implement a true spiral curriculum building on lessons of knowledge, skills, and attitudes throughout the 4-year student experience. The current UMCMS curriculum involves most courses at the medical school, has community-based and interprofessional components, and is taught using multimedia. Most of the curriculum is mandatory with selective opportunities for those in specialty tracks or who are seeking more hands-on training. Our study evaluated the UMCMS curriculum using the AAMC and CIPCOH EPA guidelines. Findings show that all students receive training in 42 of 48 AAMC oral health competencies and seven of seven CIPCOH oral health EPAs with the opportunity to explore oral health further through elective courses. Assessments of students show they perform well and evaluation of the oral health curricula by students are positive. Although our oral health curriculum is robust, the next steps include expanding the evaluation of students to ensure they universally meet competencies. We expect that this case study can serve as a map for creating a generalizable, spiral curriculum for other medical schools.