ISSUE
     
Combining Technology and Ingenuity to Educate Tomorrow's Dentists
Learning to Treat Survivors of Torture:
 










A UNIQUE EDUCATIONAL PROGRAM MEETS THE NEEDS OF A UNIQUE PATIENT POPULATION

Students at the NYU College of Dentistry have access to the largest, most culturally diverse pool of dental patients in our nation, including many with multiple diseases and systemic conditions in addition to their oral health needs. As a result, many NYU dental students believe that they have encountered every imaginable physical condition. But despite the breathtaking diversity of our patients and the range of their healthcare needs, until last summer, when NYUCD introduced the first program in the U.S. designed to educate dental students specifically to provide dental services for survivors of torture, there existed a category of needs to which dental students had never before been exposed.

Because of its enduring status as a haven for political refugees, the United States, and New York City in particular, draws a disproportionate number of survivors of politically motivated torture from around the world, the majority of whom suffer from post-traumatic stress disorder. Haunted by memories of physical torture, survivors have to deal with persistent frightening thoughts and memories of their ordeal, in addition to having to overcome routine fears of dentistry. As a result, their ability to access dental care is seriously compromised.

NYUCD's PSOT (Program for Survivors of Torture) is our attempt to help survivors overcome these barriers to care. The program, introduced last summer, is an offshoot of the Bellevue/NYU Program for Survivors of Torture, which was established in 1995 to provide comprehensive medical and mental health care, as well as social and legal services, for survivors of torture and war traumas and their family members from over 80 countries. NYUCD's program was developed in consultation with the leaders of the Bellevue/NYU Program and is designed specifically to complement the services it provides.

Following a rigorous selection process, 12 senior NYU dental students were chosen to participate in the inaugural program. To prepare for their assignment, students took part in a series of interactive seminars focusing on the special physical and psychological needs of survivors of torture; attended lectures sponsored by the Bellevue/NYU Program for Survivors of Torture; and rotated through the Bellevue Program on Monday evenings, joining the medical team in history taking, physical examinations, and psychological intake sessions. As co-directors of the course, our educational objectives were to familiarize the students with the prevalence and nature of politically motivated torture, and to make them aware of the psychological profiles of the patients and the medical conditions and pain syndromes typically experienced by this population. These sessions also served to reduce the fear of the unknown for our students and introduced them to the amazing stories of survival among this population.

Between 20 and 25 patients referred by the Bellevue program come to NYUCD every Friday for diagnosis and treatment. The majority of these patients, including many who came to the U.S. from sub-Saharan Africa, Tibet, and Southeast Asia, do not speak English and require interpreters in order to communicate. This necessitated having Bellevue Hospital Social Services staff train our students to provide care utilizing an interpreter, while striving to maintain the intimacy of the doctor-patient relationship. In order to provide these patients with the most supportive environment possible as well as the finest care, we developed a set of principles to guide us in equipping our students with the requisite skills to treat a patient population with extremely complex psychological as well as physical needs. These principles are: ownership, preparedness, critical thinking, and self- and peer evaluation.

We sought to empower our students to take ownership of the program by taking responsibility for developing the daily patient schedule, creating and implementing their own weekly Bellevue rotations, and ensuring that supplies and instruments were on hand for the scheduled treatment and that instrument gathering and return protocols were efficient and predictable.

To promote preparedness, we arranged for our students to begin each treatment day with a "huddle" at 8 a.m. in the Bluestone Center conference room. During the huddle, patients to be treated that day are discussed, and procedures and rationales for care are reinforced. A weekly seminar on various dental topics is presented by faculty. Students leave the huddle feeling energized and, more important, equipped with the knowledge and confidence necessary to act in a professional manner and to produce positive outcomes for their patients.

Following each five-hour clinic session, the team retires to a seminar room for a "lunch and learn" session where the day's events and treatment outcomes are reported and discussed. The sessions reinforce the students' ability to think critically, based on an in-depth understanding of the science underlying clinical decisions made and procedures selected, and to articulate the nuances they've come to understand as necessary in treating this population.

Honest and forthright self- and peer evaluation is another of the cornerstones of the professionalism we strive to cultivate. The students work in teams of two, which provides a means of peer evaluation at the same time that it promotes efficiency. Students are encouraged to consult with each other on their cases and to communicate discreetly with one another and with supervising faculty during treatment in order to ensure the most appropriate course of treatment. This process is enhanced by the privacy and intimacy of the clinical space in which the program operates and by the open, honest relationships that exist between faculty and students.

Participating students understand that it is a privilege to contribute to the oral and psychological health of this population and to help nurture them back to wellness and wholeness. Indeed, students often refer to Friday as "my favorite day of the week." When a student says, "I feel that I have not only helped a patient to overcome psychological and dental issues, but that I have also helped to undo a wrong perpetrated by society," we know that the education these students have received has been effective and has further broadened their understanding of what it means to be exposed to every possible physical condition patients may present.