A clinical audit of the comprehensive care dentistry model in the internship clinics of a dental school in Pakistan.

BACKGROUND: Comprehensive Care clinics in dental education aim to train doctors in patient- centered, holistic care, focusing on multi-disciplinary treatment provision. There has been a rapid global paradigm shift within the last decade in dental educational models, shifting from departmental training to comprehensive care clinics. This study describes the establishment, feasibility, and outcomes of a pioneer Comprehensive Care Dentistry (CCD) clinic, which was established in a tertiary care Dental Institute in Lahore, Pakistan. The aim is to present the barriers in establishment of Comprehensive Care dental clinics, in dental school of a resource limited country. It also aims to present strengths, weaknesses, and alternative feasible models of this educational system. METHODS: This observational and audit-based study involved the establishment of a comprehensive care dental clinic in a tertiary care dental institute, with systematic documentation and audits of clinical workflows, treatment planning protocols, case allocations and 360-degree feedback from all primary stakeholders, over the first year of clinic's operation. Data was collected via feedback forms from primary stakeholders, clinical records, and faculty observations. Key performance indicators such as cross infection protocols, patient turnover and satisfaction, material usage, interdepartmental coordination, and patient completion rates were assessed. Hindrances and facilitators to implementation were identified via focused administrative and faculty discourses. RESULTS: The clinic provided a structured, patient centered, multidisciplinary approach towards patient care. It had a positive role in enhancing interns' communication skills, interprofessional coordination and continuity of care. Improved accountability amongst interns, cohesive treatment provision and high patient satisfaction was observed. Challenges identified included lack of faculty coordination and acceptance, variations in treatment plans amongst different consultants and administrative limitations. Overall feasibility, treatment provision and educational value were positively received by all stakeholders. CONCLUSION: The present study suggested the need to revise dental education modes from discipline-driven numerical requirements to a patient-centred comprehensive care curriculum for the timely professional grooming of dental graduates. CCD positively influences the quality of student learning as well as patient care. Students and patients experience a better learning and treatment experience respectively within this system. In a resource limited country like Pakistan, there are still hindrances in resources and acceptance within faculty for this system but with perseverance and modifications as per feasibility of each dental school, this system may prove to be very successful. Curricular modification may be required for inculcation of this system, within evolving dental education.