European Journal of Dental Education ISSN 1396-5883
Special Needs Dentistry: perception, attitudes and educational experience of Malaysian dental students M. S. Ahmad1,2, I. A. Razak3 and G. L. Borromeo2 1 2 3
Universiti Teknologi MARA, Shah Alam, Malaysia, University of Melbourne, Victoria, Australia, Vinayaka Missions International University College, Petaling Jaya, Malaysia
keywords special care dentistry; special needs dentistry; dental education; disability; special health care needs. Correspondence Mina Borromeo Melbourne Dental School 720 Swanston Street Carlton VIC 3053 Australia Tel: +61393411489 Fax: +61393411599 e-mail: [email protected] The study was funded by the Melbourne Dental School Postgraduate Research Grant. Accepted: 3 March 2014 doi: 10.1111/eje.12101
Abstract A compromised oral health condition amongst patients with special health care needs (SHCN) has been associated with the reluctance and shortage of skills of dental professionals in managing such patients. Lack of training and experience at the undergraduate level are reported barriers to the provision of care for this patient cohort. Undergraduate education therefore, plays an important role in producing professionals with the knowledge, skills and positive attitude in treating patients with SHCN. This study aims to determine the level of knowledge, comfort and attitudes of Malaysian undergraduate dental students towards caring for patients with SHCN, as well as their perception on education in this field. A self-administered questionnaire was administered in the classroom style to final year undergraduate dental students in Malaysian public dental schools. Most students were aware of Special Needs Dentistry (SND) as a specialty after being informed by academic staff. The majority of the students demonstrated poor knowledge in defining SND and felt uncomfortable providing care for such patients. They perceived their undergraduate training in SND as inadequate with most students agreeing that they should receive didactic and clinical training at undergraduate level. A high percentage of students also expressed interest in pursuing postgraduate education in this area of dentistry despite the lack of educational exposure during undergraduate years. The study supports a need for educational reform to formulate a curriculum that is more patient-centred, with earlier clinical exposure in various clinical settings for students to treat patients with special health care needs, applying the concept of holistic care in a variable clinical condition.
Introduction The rapid advancement in health sciences has contributed to a reduction in mortality rates, which subsequently results in an ageing population and increased numbers of people living with chronic health conditions (1). This accounts for the rising number of people living with disabilities who have special health care needs (SHCN). The World Health Survey (2010) estimated that disability affects 15% of the world population, which is 5% higher than reported in the 1970s (1). Of these, 2.2% have significant difficulties in functioning, which affects their activities of daily living (1). The impact of disability does not only affect the individuals themselves, but also impacts the surrounding environment including family and carers, and support systems, as well as delivery of health care services. It has been recognised that people living with disabilities and special health care needs have poor health outcomes and extensive health care requirements which are often unmet (2–4). Cardiovascular diseases, respiratory disorders, musculoskeletal
44
dysfunction, metabolic diseases and sexual complications were reported to be higher in this group of individuals, resulting in higher rates of hospital admissions (5–11). Poorer oral health status was also found to be more prevalent with high levels of unmet needs and reduced access to oral health care services (12–19). Barriers in utilisation of oral health care services amongst people with SHCN may be multi-factorial. Financial constraints, inadequate availability of trained personnel, lack of awareness, physical barriers and difficulties related to a patient’s health have been associated with compromised oral health care amongst patients with SHCN (20, 21). Article 25 of the United Nation’s Convention on the Rights of Persons with Disabilities highlights the rights of people with disabilities to obtain quality health care services on an equal basis with others (22). It is thus crucial to implement effective measures in handling issues to provide better access to oral health care for individuals with SHCN, aimed at enhancing their quality of life and psychological well-being. The Lifetime Oral Health Care for Patients with ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 19 (2015) 44–52
Ahmad et al.
Special Needs Symposium 2006 had addressed the importance of formulating a health care system which provides an equitable distribution of oral health care services that placed a focus on individuals with SHCN (23). Improving access and status of oral health for people with SHCN requires an insight into social determinants of health inequalities which are beyond policy making and government funding. Human capital plays a vital role in dealing with this issue. It was estimated that a large proportion of patients with SHCN could be treated in a general dental practice settings (24). In many countries, general dentists have been primarily involved in caring for people with SHCN by providing preventative care and dental treatment (25–30). As dentists play a vital role in providing care for people with SHCN, it is therefore imperative for dentists to be adequately trained and acquire a strong basis in delivery of care, taught within the scope of Special Needs Dentistry (SND). Special Needs Dentistry involves managing oral health care in those with intellectual disabilities, medical, physical, or psychiatric conditions. Special methods or techniques for prevention and treatment of oral health necessitates special dental treatment plans, methods, and technique modifications (31). In the United Kingdom, the term ‘Special Care Dentistry’ (SCD) is employed, which is centred around the improvement of oral health care of adolescents and adults who are unable to accept routine dental care because of some physical, intellectual, medical, emotional, sensory, mental or social impairment, or a combination of these factors, by providing preventive treatment and oral health care services, which requires a holistic approach that is specialist-led to meet the complex requirements of people with impairments (General Dental Council of UK, 2010) (32). Special Needs Dentistry and SCD terms are often used interchangeably on a global level, with different definitions and scope of practice which is determined by the oral health needs, environmental and personal factors as well as availability of resources within the local context (33). Special Needs Dentistry is starting to gain recognition as a dental specialty worldwide with the establishment of postgraduate programmes to produce professionals performing at specialist level (31). There is also a strong recognition towards developing an undergraduate curriculum in SND, realising its potential towards reducing health inequalities and improvement of oral health care among the population of people with SHCN (34, 35). It was reported that dentists who had undergone training in SND during their undergraduate years treated more patients with SHCN and have better attitudes towards providing care for this patient group, compared to dentists who were not exposed to such educational experience at undergraduate level (36). It is imperative that education in SND should start in the undergraduate years to produce dentists who are able to accommodate the needs and demands for oral health care of people with SHCN, thus reducing the burden of oral diseases. Despite realising the role of education to prepare the profession to meet the current and future challenges in providing care for individuals with SHCN, many dental schools are still not providing adequate training for the management of this patient group. Students reported insufficient training and expressed concerns over the need for increased didactic teaching and clinical preparation in the care of individuals with ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 19 (2015) 44–52
Special Needs Dentistry: Malaysian students’ perception
SHCN at undergraduate level (37–39). Therefore, it is essential to determine the students’ perception of their educational experience in SND to assess the efficacy of current teaching and training at undergraduate level. This would then allow the identification of areas in the curriculum that may need to be improved on to increase the awareness and comfort levels of students in this field. The current study is conducted in Malaysia, a country gaining recognition towards SND as a specialty. It would provide important information as to the level of interest and competency amongst dental undergraduates across Malaysia in treating patients with SHCN. It will also provide feedback and help gauge the interest, direction of growth and current acceptance of SND as a scope of practice amongst undergraduate students together with important information that can impact on curriculum development in SND in Malaysian Dental Schools.
Materials and methods A self-administered questionnaire was conducted, class-room style, on final year undergraduate dental students of Malaysian public dental schools at the end of the 2011/2012 academic year. The questionnaire consisted of four sections: Socio-demographic characteristics, perception of SND, perception of patients with SHCN, and training programmes for SND. The study utilised the same questionnaire conducted previously on Australian samples (40). The survey consisted of closed and open ended questions and Likert scales to rate students’ perceptions of SND education, experience, and level of comfort in treating patients with SHCN. The ability of students to define SND was categorised according to the definition set by the Royal Australasian College of Dental Surgeons (RACDS) (41). Four categories of SND were identified including intellectual disabilities, complex medical conditions, physical disabilities, and psychiatric issues. Students who were able to identify two or more categories were classified as having ‘adequate’ knowledge, whereas students who identified one or less were classified as having ‘poor’ knowledge in defining SND. Data were de-identified, used in aggregate form only and statistically analysed using the SPSS Version 20 (Melbourne, Victoria, Australia). Further analysis was undertaken using a Chi-square regression analysis with the significance value taken as P ≤ 0.01. Ethics was obtained through the University of Melbourne Human Research Ethics Committee and the Medical Ethics Committee, Dental Faculty, University of Malaya.
Results Demographic characteristics The response rate was 100% for all six universities with the exception of University A, which was 92.7%. All universities have substantially more female students than males (Table 1).
Definition of SND The majority of students claimed that they were able to define SND (83.0% vs. 17.0%) regardless of which university they 45
Special Needs Dentistry: Malaysian students’ perception
Ahmad et al.
TABLE 1. Gender breakdown across the six universities University University University University University University University Total
A B C D E F
Male n (%)
Female n (%)
21 16 12 6 12 10 77
55 51 38 26 23 19 212
(27.6) (23.9) (24.0) (18.8) (34.3) (34.5) (26.6)
(72.4) (76.1) (76.0) (81.3) (65.7) (65.5) (73.4)
attended, with over 68.8% across all universities claiming to have the ability to define SND (v2 = 6.017, P = 0.31). There was a significant association between the students’ actual ability to define SND and the university they attended (v2 = 45.186, P ≤ 0.01).The majority of students demonstrated poor knowledge in defining SND across all universities except for University A (Fig. 1). Students were asked to specifically define SND and this was categorised according to the RACDS SND definition. The four main categories identified included physical disabilities (49.6%), complex medical conditions (27.9%), intellectual disabilities (15.4%) and psychiatric issues (8.8%). Students also identified other groups of SND patients that were not included in the RACDS definition including mental disabilities (40.0%), emotional impairment (13.3%), social impairment (10.0%) and sensory impairment (5.0%).
Terminology and awareness for the specialty Overall, there was no appreciable difference in preference for the term ‘Special Needs Dentistry’ (47.4%) over ‘Special Care Dentistry’ (46.7%). There was a strong association between universities attended and terminology preference with students
from University A preferring ‘Special Care Dentistry’ over ‘Special Needs Dentistry’ (80.3%) and all other universities preferring the latter terminology (University B 59.7%; University C 54%; University D 68.8%; University E 45.7% and University F 58.6%) (v2 = 38.96; P ≤ 0.01). A majority of dental students were aware of SND as a specialty (84.4% vs. 15.6%). Students from University E (60%) were less aware of the specialty compared to other universities (University A 78.9%; University B 92.5%; University C 88.0%; University D 96.9%; University F 89.7%) (v2 = 25.83, P ≤ 0.01). In terms of how this awareness came about, 75.1% of students received information from academic staff with a further 10% after reading about the topic and 3.5% from the internet. 3.5% of students had never heard of SND with a further 7.9% citing other resources.
Students’ exposure in treating patients with SHCN About three quarters (77.5%) of dental students had been exposed to clinical experience treating elderly patients. Students also reported to have gained clinical experience in treating other categories of SND patients, although at a lower percentage, which include those with complex medical problems (38.1%), psychological or behavioural issues (23.2%), infectious diseases (18.3%), physical disabilities (16.6%), intellectual disabilities (12.5%) and visual/hearing impairments (4.8%) (Fig. 2).
Students’ attitudes towards providing treatment to different categories of patients with SHCN Students were required to rate their level of comfort in treating different groups of patients with SHCN following graduation given their educational experience at undergraduate level.
100
Poor Adequate
90 80
Percentage
70 60 50 40 30 20 10 0
University A
University B
University C
University D
University E
University F
Fig. 1. Ability of students to adequately define Special Needs Dentistry (SND) across the six Malaysian public dental schools.
46
ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 19 (2015) 44–52
Ahmad et al.
Special Needs Dentistry: Malaysian students’ perception
90
Students exposed to clinical experience Students felt comfortable to provide care
80
Percentage
70 60 50 40 30 20 10 0
ELD
CMP
PSY
INF
PD
ID
VHI
Fig. 2. Percentage of students exposed to clinical experience in treating special needs patients vs. the percentage of students who felt comfortable providing treatment following graduation (ELD, elderly; CMP, complex medical condition; PSY, psychological/behavioural issues; INF, infectious disease; PD, physical disability; ID, intellectual disability; VHI, visual/hearing impairment).
82.8% of the students felt comfortable treating elderly patients, whilst 50.7% felt comfortable treating patients with a physical disability. However, a low percentage was observed in other categories of patients with SHCN including those with visual/ hearing impairments (45.9%), complex medical conditions (39.5%), intellectual disabilities (31.7%), infectious diseases (21.2%), and psychological or behavioural issues (19.8%). In spite of this, the percentage of students who felt comfortable treating patients with physical disabilities, intellectual disabilities and visual/hearing impairments was more than twice as high compared to the percentage of students who received clinical exposure treating these patients during undergraduate years (Fig. 2).
Educational experience in treating patients with SHCN at undergraduate level Fifty-five percentage to 88% of students with clinical exposure in treating patients with SHCN rated a positive experience while treating the different patient categories, except for those with psychological or behavioural issues, for which slightly
Special Needs Dentistry: perception, attitudes and educational experience of Malaysian dental students M. S. Ahmad1,2, I. A. Razak3 and G. L. Borromeo2 1 2 3
Universiti Teknologi MARA, Shah Alam, Malaysia, University of Melbourne, Victoria, Australia, Vinayaka Missions International University College, Petaling Jaya, Malaysia
keywords special care dentistry; special needs dentistry; dental education; disability; special health care needs. Correspondence Mina Borromeo Melbourne Dental School 720 Swanston Street Carlton VIC 3053 Australia Tel: +61393411489 Fax: +61393411599 e-mail: [email protected] The study was funded by the Melbourne Dental School Postgraduate Research Grant. Accepted: 3 March 2014 doi: 10.1111/eje.12101
Abstract A compromised oral health condition amongst patients with special health care needs (SHCN) has been associated with the reluctance and shortage of skills of dental professionals in managing such patients. Lack of training and experience at the undergraduate level are reported barriers to the provision of care for this patient cohort. Undergraduate education therefore, plays an important role in producing professionals with the knowledge, skills and positive attitude in treating patients with SHCN. This study aims to determine the level of knowledge, comfort and attitudes of Malaysian undergraduate dental students towards caring for patients with SHCN, as well as their perception on education in this field. A self-administered questionnaire was administered in the classroom style to final year undergraduate dental students in Malaysian public dental schools. Most students were aware of Special Needs Dentistry (SND) as a specialty after being informed by academic staff. The majority of the students demonstrated poor knowledge in defining SND and felt uncomfortable providing care for such patients. They perceived their undergraduate training in SND as inadequate with most students agreeing that they should receive didactic and clinical training at undergraduate level. A high percentage of students also expressed interest in pursuing postgraduate education in this area of dentistry despite the lack of educational exposure during undergraduate years. The study supports a need for educational reform to formulate a curriculum that is more patient-centred, with earlier clinical exposure in various clinical settings for students to treat patients with special health care needs, applying the concept of holistic care in a variable clinical condition.
Introduction The rapid advancement in health sciences has contributed to a reduction in mortality rates, which subsequently results in an ageing population and increased numbers of people living with chronic health conditions (1). This accounts for the rising number of people living with disabilities who have special health care needs (SHCN). The World Health Survey (2010) estimated that disability affects 15% of the world population, which is 5% higher than reported in the 1970s (1). Of these, 2.2% have significant difficulties in functioning, which affects their activities of daily living (1). The impact of disability does not only affect the individuals themselves, but also impacts the surrounding environment including family and carers, and support systems, as well as delivery of health care services. It has been recognised that people living with disabilities and special health care needs have poor health outcomes and extensive health care requirements which are often unmet (2–4). Cardiovascular diseases, respiratory disorders, musculoskeletal
44
dysfunction, metabolic diseases and sexual complications were reported to be higher in this group of individuals, resulting in higher rates of hospital admissions (5–11). Poorer oral health status was also found to be more prevalent with high levels of unmet needs and reduced access to oral health care services (12–19). Barriers in utilisation of oral health care services amongst people with SHCN may be multi-factorial. Financial constraints, inadequate availability of trained personnel, lack of awareness, physical barriers and difficulties related to a patient’s health have been associated with compromised oral health care amongst patients with SHCN (20, 21). Article 25 of the United Nation’s Convention on the Rights of Persons with Disabilities highlights the rights of people with disabilities to obtain quality health care services on an equal basis with others (22). It is thus crucial to implement effective measures in handling issues to provide better access to oral health care for individuals with SHCN, aimed at enhancing their quality of life and psychological well-being. The Lifetime Oral Health Care for Patients with ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 19 (2015) 44–52
Ahmad et al.
Special Needs Symposium 2006 had addressed the importance of formulating a health care system which provides an equitable distribution of oral health care services that placed a focus on individuals with SHCN (23). Improving access and status of oral health for people with SHCN requires an insight into social determinants of health inequalities which are beyond policy making and government funding. Human capital plays a vital role in dealing with this issue. It was estimated that a large proportion of patients with SHCN could be treated in a general dental practice settings (24). In many countries, general dentists have been primarily involved in caring for people with SHCN by providing preventative care and dental treatment (25–30). As dentists play a vital role in providing care for people with SHCN, it is therefore imperative for dentists to be adequately trained and acquire a strong basis in delivery of care, taught within the scope of Special Needs Dentistry (SND). Special Needs Dentistry involves managing oral health care in those with intellectual disabilities, medical, physical, or psychiatric conditions. Special methods or techniques for prevention and treatment of oral health necessitates special dental treatment plans, methods, and technique modifications (31). In the United Kingdom, the term ‘Special Care Dentistry’ (SCD) is employed, which is centred around the improvement of oral health care of adolescents and adults who are unable to accept routine dental care because of some physical, intellectual, medical, emotional, sensory, mental or social impairment, or a combination of these factors, by providing preventive treatment and oral health care services, which requires a holistic approach that is specialist-led to meet the complex requirements of people with impairments (General Dental Council of UK, 2010) (32). Special Needs Dentistry and SCD terms are often used interchangeably on a global level, with different definitions and scope of practice which is determined by the oral health needs, environmental and personal factors as well as availability of resources within the local context (33). Special Needs Dentistry is starting to gain recognition as a dental specialty worldwide with the establishment of postgraduate programmes to produce professionals performing at specialist level (31). There is also a strong recognition towards developing an undergraduate curriculum in SND, realising its potential towards reducing health inequalities and improvement of oral health care among the population of people with SHCN (34, 35). It was reported that dentists who had undergone training in SND during their undergraduate years treated more patients with SHCN and have better attitudes towards providing care for this patient group, compared to dentists who were not exposed to such educational experience at undergraduate level (36). It is imperative that education in SND should start in the undergraduate years to produce dentists who are able to accommodate the needs and demands for oral health care of people with SHCN, thus reducing the burden of oral diseases. Despite realising the role of education to prepare the profession to meet the current and future challenges in providing care for individuals with SHCN, many dental schools are still not providing adequate training for the management of this patient group. Students reported insufficient training and expressed concerns over the need for increased didactic teaching and clinical preparation in the care of individuals with ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 19 (2015) 44–52
Special Needs Dentistry: Malaysian students’ perception
SHCN at undergraduate level (37–39). Therefore, it is essential to determine the students’ perception of their educational experience in SND to assess the efficacy of current teaching and training at undergraduate level. This would then allow the identification of areas in the curriculum that may need to be improved on to increase the awareness and comfort levels of students in this field. The current study is conducted in Malaysia, a country gaining recognition towards SND as a specialty. It would provide important information as to the level of interest and competency amongst dental undergraduates across Malaysia in treating patients with SHCN. It will also provide feedback and help gauge the interest, direction of growth and current acceptance of SND as a scope of practice amongst undergraduate students together with important information that can impact on curriculum development in SND in Malaysian Dental Schools.
Materials and methods A self-administered questionnaire was conducted, class-room style, on final year undergraduate dental students of Malaysian public dental schools at the end of the 2011/2012 academic year. The questionnaire consisted of four sections: Socio-demographic characteristics, perception of SND, perception of patients with SHCN, and training programmes for SND. The study utilised the same questionnaire conducted previously on Australian samples (40). The survey consisted of closed and open ended questions and Likert scales to rate students’ perceptions of SND education, experience, and level of comfort in treating patients with SHCN. The ability of students to define SND was categorised according to the definition set by the Royal Australasian College of Dental Surgeons (RACDS) (41). Four categories of SND were identified including intellectual disabilities, complex medical conditions, physical disabilities, and psychiatric issues. Students who were able to identify two or more categories were classified as having ‘adequate’ knowledge, whereas students who identified one or less were classified as having ‘poor’ knowledge in defining SND. Data were de-identified, used in aggregate form only and statistically analysed using the SPSS Version 20 (Melbourne, Victoria, Australia). Further analysis was undertaken using a Chi-square regression analysis with the significance value taken as P ≤ 0.01. Ethics was obtained through the University of Melbourne Human Research Ethics Committee and the Medical Ethics Committee, Dental Faculty, University of Malaya.
Results Demographic characteristics The response rate was 100% for all six universities with the exception of University A, which was 92.7%. All universities have substantially more female students than males (Table 1).
Definition of SND The majority of students claimed that they were able to define SND (83.0% vs. 17.0%) regardless of which university they 45
Special Needs Dentistry: Malaysian students’ perception
Ahmad et al.
TABLE 1. Gender breakdown across the six universities University University University University University University University Total
A B C D E F
Male n (%)
Female n (%)
21 16 12 6 12 10 77
55 51 38 26 23 19 212
(27.6) (23.9) (24.0) (18.8) (34.3) (34.5) (26.6)
(72.4) (76.1) (76.0) (81.3) (65.7) (65.5) (73.4)
attended, with over 68.8% across all universities claiming to have the ability to define SND (v2 = 6.017, P = 0.31). There was a significant association between the students’ actual ability to define SND and the university they attended (v2 = 45.186, P ≤ 0.01).The majority of students demonstrated poor knowledge in defining SND across all universities except for University A (Fig. 1). Students were asked to specifically define SND and this was categorised according to the RACDS SND definition. The four main categories identified included physical disabilities (49.6%), complex medical conditions (27.9%), intellectual disabilities (15.4%) and psychiatric issues (8.8%). Students also identified other groups of SND patients that were not included in the RACDS definition including mental disabilities (40.0%), emotional impairment (13.3%), social impairment (10.0%) and sensory impairment (5.0%).
Terminology and awareness for the specialty Overall, there was no appreciable difference in preference for the term ‘Special Needs Dentistry’ (47.4%) over ‘Special Care Dentistry’ (46.7%). There was a strong association between universities attended and terminology preference with students
from University A preferring ‘Special Care Dentistry’ over ‘Special Needs Dentistry’ (80.3%) and all other universities preferring the latter terminology (University B 59.7%; University C 54%; University D 68.8%; University E 45.7% and University F 58.6%) (v2 = 38.96; P ≤ 0.01). A majority of dental students were aware of SND as a specialty (84.4% vs. 15.6%). Students from University E (60%) were less aware of the specialty compared to other universities (University A 78.9%; University B 92.5%; University C 88.0%; University D 96.9%; University F 89.7%) (v2 = 25.83, P ≤ 0.01). In terms of how this awareness came about, 75.1% of students received information from academic staff with a further 10% after reading about the topic and 3.5% from the internet. 3.5% of students had never heard of SND with a further 7.9% citing other resources.
Students’ exposure in treating patients with SHCN About three quarters (77.5%) of dental students had been exposed to clinical experience treating elderly patients. Students also reported to have gained clinical experience in treating other categories of SND patients, although at a lower percentage, which include those with complex medical problems (38.1%), psychological or behavioural issues (23.2%), infectious diseases (18.3%), physical disabilities (16.6%), intellectual disabilities (12.5%) and visual/hearing impairments (4.8%) (Fig. 2).
Students’ attitudes towards providing treatment to different categories of patients with SHCN Students were required to rate their level of comfort in treating different groups of patients with SHCN following graduation given their educational experience at undergraduate level.
100
Poor Adequate
90 80
Percentage
70 60 50 40 30 20 10 0
University A
University B
University C
University D
University E
University F
Fig. 1. Ability of students to adequately define Special Needs Dentistry (SND) across the six Malaysian public dental schools.
46
ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 19 (2015) 44–52
Ahmad et al.
Special Needs Dentistry: Malaysian students’ perception
90
Students exposed to clinical experience Students felt comfortable to provide care
80
Percentage
70 60 50 40 30 20 10 0
ELD
CMP
PSY
INF
PD
ID
VHI
Fig. 2. Percentage of students exposed to clinical experience in treating special needs patients vs. the percentage of students who felt comfortable providing treatment following graduation (ELD, elderly; CMP, complex medical condition; PSY, psychological/behavioural issues; INF, infectious disease; PD, physical disability; ID, intellectual disability; VHI, visual/hearing impairment).
82.8% of the students felt comfortable treating elderly patients, whilst 50.7% felt comfortable treating patients with a physical disability. However, a low percentage was observed in other categories of patients with SHCN including those with visual/ hearing impairments (45.9%), complex medical conditions (39.5%), intellectual disabilities (31.7%), infectious diseases (21.2%), and psychological or behavioural issues (19.8%). In spite of this, the percentage of students who felt comfortable treating patients with physical disabilities, intellectual disabilities and visual/hearing impairments was more than twice as high compared to the percentage of students who received clinical exposure treating these patients during undergraduate years (Fig. 2).
Educational experience in treating patients with SHCN at undergraduate level Fifty-five percentage to 88% of students with clinical exposure in treating patients with SHCN rated a positive experience while treating the different patient categories, except for those with psychological or behavioural issues, for which slightly
