Family Medicine & Community Health Elective Course Description

Hugh Silk, MD

Elective Description:

Objectives: At the conclusion of the elective, students should:

1. Appreciate the significance of oral disease on overall health in Worcester and Massachusetts across the life cycle
2. Have the skills to take a risk history for oral disease, counsel about oral health promotion, make appropriate referrals
3. Be aware of local oral health resources for people of all ages and with various medical issues
4. Learn specific procedural skills such as fluoride varnish and possibly other oral interventions including regional oral anesthetic blocks
5. Team approach to oral care including how hygienists, oral surgeons, physicians can work together on issues like cleft lip and palate, caries prevention and special needs patients

Location: The elective takes place at various sites in Worcester under the supervision of Dr. Hugh Silk.

Student Role: The student will be responsible for setting up their own schedule under the guidance of Dr. Silk, in accordance with the goals of the elective, the particular interests of the student, and the availability of the community preceptors at the various sites (see below for options).  Given the nature of the elective, the student will spend time in informal and formal didactic sessions at least once per week, and will review recent literature on diseases or problems encountered throughout the elective.  Educational sites will be suggested including the American Academy of Family Physicians/Society of Teachers in Family Medicine Smiles for Life Oral Health Curriculum (www.smilesforlifeoralhealth.org) and other oral health web sites that are links found on this web site. A packet of articles will be provided as well.  See writing exercise below

Note: Student should be prepared to be very proactive at each site; it is imperative that the student ask lots of questions of site preceptors. 

Writing Exercise: Each student over the course of the elective will be asked to write something that helps to deepen the lessons of the elective.  Opportunities to write include: assisting Dr Silk write an article for a journal like American Family Physician on an oral health topic; writing an editorial for a local paper; creating a handout for primary care doctors on an oral health topic; editing a chapter in 5 Minute Clinical Consult on one of the oral health chapters Dr. Silk edits annually; writing a reflective piece about the elective for the Thursday Morning Memo (a weekly list-serve that Dr. Silk edits that tells clinical success storied in family medicine.) Discuss with Dr. Silk when planning the elective.

Discussion: Since primary care physicians deal with problems related to oral health, the elective serves to help strengthen such training for those entering a career in primary care with children and/or adults.  In general, the student will learn about the different medications used to treat oral pathology, as well as effective prevention and education related to oral health.  The elective is type B2, as the student will have direct contact with patients as a major feature of the elective. The student will see an average of at least 6 patients per day on days of patient care activities.  The student will obtain appropriate histories when indicated, perform appropriate physical examinations and learn to offer diagnostic and therapeutic alternatives.  The student will not have primary responsibility for patients, but rather will work with various physicians, dentists, and dental hygienists at the sites described above.  The elective will be two-  four weeks long in duration, and the student will be graded according to attitude, demonstration of learning, and ability to synthesize information and develop an appropriate diagnosis and treatment plan, as well as ability to perform appropriate physical examinations.  The student will take a pre/post multiple choice test from the Smiles for Life curriculum.  Dr. Silk will grade the student taking into consideration these areas, assigning a grade of outstanding, above expected, expected, below expected or no credit.

Readings: Dr. Silk has a series of articles that he will send students to read during the month.

Resources:

Smiles for Life:  The student should go through all 8 modules on day one of the elective.  Review Module 1 Systemic-Oral Health first, then Module 7 The Oral Exam (which will include information on basic tooth and mouth anatomy as well as an approach to the pediatric and adult exam) and then the other 6 modules.  There are cases and test questions with each module that should be completed.  There are also helpful instructional videos.  See www.smilesforlifeoralhealth.org.

UMASS Care Mobile: The student will spend several hours on the UMass Care Mobile, seeing patients with the medical and dental providers, to learn about barriers to dental care, as well as the specific issues addressed in the setting of the Care Mobile.  On the Care Mobile, the student will educate patients about dental care, perform screening oral exams, and apply fluoride varnish.  The student will spend some time with dental hygienists to learn about techniques for examining mouths, particularly of children, and prevention of caries.  The student may also accompany the Care Mobile on visits to schools in the Worcester area (when available) to educate children and apply fluoride varnish; Mondays 10-4, Wed 9-3, Thurs 9-3.  Contact:  774-230-5260 Sara Connor (sara.connor@umassmemorial.org). 508-334-7311 or 508-930-0524

Dental Residency: The student will spend time with Lutheran dental residents and with the Dental Residency Director at the Family Health Center of Worcester Dental Center to learn first hand about common oral pathology and treatments, and to provide oral health screenings and fluoride treatments to patients. 26 Queen St, 3^rd floor (508) 860-7910 Contact: Martha Sullivan, Health Center Dental Director (Martha.sullivan@umassmed.edu).

UMass Craniofacial Clinic: The student can spend a day in the Craniofacial Clinic at UMass to learn about cleft palates and other head and facial abnormalities, as well as treatment and care of such patients in an interdisciplinary setting.  This is a great opportunity to learn about team care for an oral problem including speech, nutrition, genetics, dentistry, etc.  Best to follow one patient/family through the process.  Wednesdays; once per month only (2^nd wed every month); 8:30-1pm. Main number: 508-334-5969 Contact: Janice Lalikos (Janice.Lalikos@umassmemorial.org)  Specialty clinic of Benedict 2. Contact Holly O’Neill 2 days before to confirm Holly.ONeil@umassmemorial.org.

Oral Surgeon: The student can work with Dr. Rod Lewin, an oral surgeon in Fitchburg, to learn hands-on approach to regional nerve blocks of the mouth and about tooth extraction and incision and drainage of dental abscesses.  Dr Lewin will cover topics of ABCs of airway maintenance, nerves of the head and neck, x-ray review, and trauma.  He will then have the student shadow a colleague in the office as he is now retired. This location will also address social issues related to dental care, and a review of oral anatomy.  Mondays and Tuesdays. Health Alliance Burbank Hospital. 326 Nichols st, Fitchburg. (When you get to Burbank Campus Hospital – go up the hill and drive around to the far side of the hospital.)  Main number: (978) 343-5000 Contact: Dr. Rod Lewin (rwldl@aol.com) (He does not respond immediately to email.)

Plastic Surgery: The student can work with plastic surgeons when they do cases pertaining to the head and neck. Contact Dr Joyce McIntyre Joyce.Mcintyre@umassmemorial.org 508-334-5931 and specifically request to observe head and neck cases.

Oral Health Advocacy: The student can travel to Boston to learn about oral health advocacy in Massachusetts through the organization Health Care For All and the Watch Your Mouth Campaign, and will also learn about the work done by the Massachusetts Department of Health’s Oral Health Division. Set up for same day. The student can attend local and state public oral health meetings and trainings with Dr. Silk as available. Contact: Hugh Silk.

Head Start: Students will work with the Head Start dental hygienist learning how to teach parents and children about good oral health and performing oral exams on young children. This is an opportunity to work with a very enthusiastic and dedicated hygienist who uses incentives for the children as she teaches.  Also very good lessons about nutrition and oral health. 337 Mill St, Mill Swan School Contact: Linda Schoonmaker Schoonmaker@worc.k12.ma.us  (508) 799-3238.

Dental Hygiene School: Students will work with dental hygiene students where they will learn tips about oral exams, hygiene advice in a wide range of patients, and hear the stories of patients who often have no dental insurance. A chance to learn a great deal about how to educate and motivate patients.  This is also a great resource to learn about for your patients.

2 options:

The Esther M. Wilkins Forsyth Dental Hygiene Clinic at MCPHS
No clinics in August. Clinics Monday and Wednesday 8am-9:30pm. 10 Lincoln Square, 3rd Floor, Worcester, MA Contact Christine Dominick, Professor at christine.dominick@mcphs.edu or 774.243.3412 and for site specifics, Robert Smethers Senior Clinic Coordinator  (Robert.smethers@mcphs.edu) or 774-243-3410).

Quinsigamond Community College School of Dental Hygiene 670 West Boylston St.  (Administration Building (seen from the road) go up the front stairs and enter the Dental Hygiene Clinic which is in front of them—the receptionist is Ms. Charlotte Santimaw) 508-853-2300 or the clinic at 508 854-4306 Contact:  Katherine (Kate) Soal Clinical Coordinator ‎[ksoal@qcc.mass.edu]‎ ; or Jane Gauthier [jgauthier@qcc.mass.edu]. Consider asking to attend on a day that Sue is teaching and also a day that the faculty dentist is present who can review xrays with you.

Oral Health Events: At certain times of the year, the elective student will be able to join others at health fairs to promote oral health, hand out toothbrushes, etc..  Contact: Hugh Silk.

Pediatric Oral Health: Students can join a busy private practice office (Worcester Kids Dentist or New England Kids) to get a sense of where referrals come from, what do the hygienists and dentist do different in a pediatric focused office, and learn skills about counseling and examining small children’s mouths.  Learn about the importance of referring children as young as 1 year; how to assess for fluoride supplements; using rewards to complete exams; how to talk to kids in a medical setting; how to practice in a humane manner and how to work with children and adults who have special needs.

Worcester Kids Dentist: 41 Lancaster St Worcester. Main Number: (508) 754-9825
Email Dr Chengeto Vera (drvera@worcesterkidsdentist.com) Wed is hygiene day

Alternatively: New England Kids in Auburn. (Tuesday and Wednesdays only)  48 Auburn St Auburn MA 508-832-6278 Dr. Anubha Sacheti ‎anubha.surati@gmail.com

Medical Primary Care Setting: Massachusetts has joined 43 other states in reimbursing primary care medical providers to assess children’s dental issues and apply fluoride varnish for children receiving Medicaid/MassHealth. Join doctors/Nurse practitioners at Plumley Village Health services as they see children for well child visits; learn the system they use to make this service easy to offer in their office and get hands-on experience examining children mouths and applying fluoride varnish.

116 Belmont st, #11, Worcester, MA main number: 508-334-1102
Contact Dr. Katharine Barnard katharine.barnard@umassmemorial.org.

Geriatric Oral Health: Students will work with a geriatric dental hygienist and dentist to learn about geriatric oral health issues. Every other Monday. 1.5 hour drive. Contact BJ Brown at  bjbsmile@comcast.net . Centre administrator: Patricia Ramsey, (603) 436-0099, The Edgewood Centre 928 South Street Portsmouth, NH.

Local General Dentists: Students can get the perspective of the new adult and pediatric oral exams (thorough), referrals, process of treating caries, periodontitis, an abscess, root canal, diabetes-oral disease in primary care, medications used in dental practice including local oral anesthetic, etc. Contact Dr. Brandon Cairo at bc@drcairo.com 102 Shore Dr #204, Worcester, MA 01605 Jacqui Esteves office coordinator [jesteves@drcairo.com] or Krystle (reception@drcairo.com) 508-852-5200. Start at 7:15am-6pm with 1.5 hour lunch Tues-Fri.

Prison Oral Health: Students can learn about the oral health issues that prisoners face when they first enter the system working alongside the dental team doing initial assessments at Concord MCI 965 Elm St Concord MA. Ernest Liacopulos, DDS Dental Director UMass Correctional Health Ernest.Liacopulos@umassmed.edu. Marlene Dodge Marlene.Dodge@umassmed.edu administrative assistant helps set up security check (need at least 1 week to do security check.) You will work with Dr Chang (DChang@mpchcare.com) but contact Dr Liacopulos first. Best days are Mondays and Fridays (Friday includes going to the SMU – segregation unit; Wednesday are possible but not as good teaching.)

Hospital Dentist: Shadow Dr Steven Ramos, oral surgeon, as he makes consults in the hospital and emergency room for urgent issues, oral infections and clearance for transplant surgery or oncology treatments.  This experience will require you to be able to be paged and meet him at either University or Memorial Campus. Email Dr Ramos at Steven.Ramos@umassmemorial.org or call Cell:  781-775-0220 or page him 508-387-5120.

Location: The  elective takes place at various sites in Worcester under the supervision of Dr. Hugh Silk.