Interprofessional Education for Oral-Systemic Health Management in Vulnerable Older Adults: A Collaborative Approach Between Dental and Nursing Students

Interprofessional Education for Oral-Systemic Health Management in Vulnerable Older Adults: A Collaborative Approach Between Dental and Nursing Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Interprofessional Education for Oral-Systemic Health Management in Vulnerable Older Adults: A Collaborative Approach Between Dental and Nursing Students Abimbola Oladayo, Mohamed Rahhal, Paul Bigg, Mary Curtis, Hanan Omar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9084945/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 16 You are reading this latest preprint version Abstract Background : The oral-systemic connection is a critical yet under-addressed component of geriatric care, despite the high burden of oral disease and preventable morbidity among older adults. Interprofessional education (IPE) offers a strategy to strengthen team-based communication, clarify professional roles, and support collaborative preventive care. Objectives: To describe the development and implementation of a joint nursing-dental IPE session integrating geriatric oral health, oral cancer screening, and vaccination content, and to evaluate students’ post-session perceptions of interprofessional collaboration using the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) instrument. Methods: A 2-hour, case-based IPE session was delivered to nursing and dental students from two institutions using a flipped-classroom model with pre-work, skills-based instruction, and interprofessional case planning. Learner perceptions were assessed post-session using the validated 10-item SPICE-R instrument. Descriptive statistics summarized responses, and internal consistency was measuring using Cronbach’s alpha. Results: Seventy-seven learners completed the post-session survey. Mean item scores ranged from 3.70 to 4.34 on a 5-point Likert scale. The mean total SPICE-R score was 41.78 ± 8.77. Subscale mean scores were 4.22 ± 0.96 for Teamwork and Team-Based Practice, 4.18 ± 0.86 for Roles and Responsibilities, and 4.12 ± 0.91 for Patient Outcomes from Collaborative Practice. Internal consistency was excellent (α = 0.97). Conclusions : This brief interprofessional education (IPE) intervention was associated with positive perceptions of teamwork and role clarity and offers a feasible, replicable approach for integrating oral-systemic care into nursing and dental curricula. Interprofessional education oral health vaccination oral cancer screening older adults SPICE-R collaborative practice Background Oral and systemic health are deeply interconnected, particularly in aging populations, who often experience polypharmacy-associated xerostomia, periodontal disease, denture-related complications, and functional limitations that compromise oral hygiene 1-4 . These conditions contribute to adverse systemic outcomes, including malnutrition, systemic inflammation, and aspiration pneumonia, one of the leading causes of morbidity and mortality in long-term care settings 5,6 . At the same time, vaccination uptake among older adults remains suboptimal despite established Centers for Disease Control and Prevention (CDC) recommendations for influenza, pneumococcal, COVID-19, and herpes zoster immunizations 7,8 . Nurses frequently provide daily oral care assistance, health education, and vaccination counseling in clinical and community settings, while dentists play a central role in identifying oral pathology and oral-systemic risk factors. Despite these complementary responsibilities, nursing and dental education have historically addressed oral health, vaccination, and preventive care in parallel rather than collaboratively 9 . As a result, nurses may feel underprepared to conduct oral assessments or make timely dental referrals, and dental trainees may have limited exposure to vaccination protocols or interprofessional care coordination for medically complex older adults. Interprofessional education (IPE) has been widely promoted as a strategy to address such fragmentation 10,11 . The Interprofessional Education Collaborative (IPEC) identifies core competencies-including shared values and ethics, role clarification, interprofessional communication, and teamwork-as essential for preparing a collaborative-ready health workforce 12 . Prior studies have demonstrated the benefits of integrating oral health content into nursing, medical, and allied health curricula, as well as the positive impact of IPE on learner perceptions of teamwork and collaborative practice 13,14 . However, few published educational models have intentionally integrated oral health promotion, oral cancer screening, and vaccination education as coequal components of preventive geriatric care within a single interprofessional learning experience. To address this gap, we designed and implemented a joint nursing-dental IPE session focused on oral-systemic integration in the care of older adults. The session emphasized preventive oral health practices, oral cancer screening, vaccination protocols, and interprofessional case management using a shared geriatric scenario. Methods Study aim : The purpose of this study was to describe the development and implementation of this IPE model and to evaluate learners’ post-session perceptions of interprofessional teamwork and collaborative practice using the validated Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) instrument. Study Design: This study employed a post-test-only quantitative design to evaluate a single-session interprofessional education (IPE) activity focused on oral-systemic preventive care for older adults. Setting and Participants: The IPE session was conducted jointly between the Goldfarb School of Nursing and A.T. Still University’s Missouri School of Dentistry & Oral Health (MOSDOH). Faculty facilitators represented both disciplines. A total of 77 learners (73 dental students and 4 graduate nursing students) participated as part of their required curricular interprofessional training. Student Learning Outcomes By the end of the session, learners were expected to: Demonstrate safe and effective preventive oral health practices for older adults, including adaptive strategies and opportunistic oral cancer screening. Apply current CDC adult vaccination guidelines and demonstrate appropriate vaccination techniques in accordance with safety protocols. Develop an integrated, team-based preventive care plan addressing oral health, vaccination, and relevant social determinants of health. Collaborate and communicate effectively across disciplines to support coordinated care for medically complex older adults. To support achievement of these outcomes, the session was structured using a flipped-classroom model that combined pre-session preparation with interactive, case-based learning. Instructional Design Prior to the in-person session, learners completed two required pre-work activities: (1) a 9-minute instructional video, Oral Health Care in Older Adults, addressing daily oral hygiene adaptations, xerostomia management, denture care, and opportunistic oral cancer screening; and (2) review of the Centers for Disease Control and Prevention (CDC) adult immunization schedule and vaccination recommendations relevant to older adults. Learners were asked to reflect on one new connection between oral health and vaccination in preventive geriatric care. The in-person session lasted 2 hours and consisted of four components: Introduction (5 minutes) : Overview of session objectives and the importance of interprofessional collaboration in oral-systemic geriatric care. Vaccination Module (45 minutes) : Instruction on CDC vaccination guidelines, the “7 Rights” of vaccine administration, intramuscular and subcutaneous injection techniques, safety considerations, and documentation requirements. Oral Health Module (45 minutes): Demonstrations and discussion focused on daily oral hygiene for older adults, xerostomia management, denture care, opportunistic oral cancer screening, and aspiration pneumonia risk reduction. Case-Based Interprofessional Activity (20 minutes): Learners worked in mixed nursing-dental teams on a shared geriatric case about a 68-year-old individual with chronic obstructive pulmonary disease, diabetes, xerostomia, poor dentition, and a recent episode of aspiration pneumonia. Using the SBAR (Situation, Background, Assessment, Recommendation) framework, teams developed a shared care plan addressing oral hygiene strategy, vaccination needs, referral pathways, and relevant social determinants of health, and practiced a brief interprofessional handoff 15 . Evaluation Learner perceptions of interprofessional collaboration were assessed using the Students’ Perceptions of Interprofessional Clinical Education–Revised (SPICE-R) instrument 16 . SPICE-R is a validated 10-item questionnaire scored on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) and includes three subscales: Teamwork and Team-Based Practice (Items 1,4,7,10) Roles and Responsibilities for Collaborative Practice (Items 2,5,8) Patient Outcomes from Collaborative Practice (Items 3,6,9) Data Analysis Survey data were collected via Qualtrics and exported for analysis. Likert-scale responses were mapped to numeric values (1–5). Descriptive statistics (means, standard deviations, ranges, and frequencies) were calculated for individual items, subscales, and the total SPICE-R score (range 10–50). Internal consistency was assessed using Cronbach’s alpha. Analyses were conducted using SPSS version 30. No inferential pre-post comparisons were performed, as no baseline survey was administered. Results Participant Completion All 77 learners who participated in the interprofessional education (IPE) session completed the post-session SPICE-R survey, yielding a 100% response rate. No cases were excluded from the analysis. Item-Level SPICE-R Findings Item-level descriptive statistics demonstrated consistently favorable perceptions of interprofessional collaboration across all SPICE-R items (Table 1 ). Mean item scores ranged from 3.70 to 4.34 on the 5-point Likert scale. The highest mean scores were observed for items reflecting perceived benefits of teamwork for understanding clinical problems and improving patient care (Q2_3, Q2_9, Q2_10). The lowest mean score was observed for the item assessing perceptions of cost reduction associated with interprofessional care (Q2_6; M = 3.70, SD = 1.18), suggesting greater uncertainty about the economic impact of team-based care relative to its perceived clinical benefits. All items demonstrated the full response range (1–5), suggesting adequate variability and engagement. Total and Subscale Scores The mean total SPICE-R score was 41.78 ± 8.77 (possible range: 10–50), indicating strong overall endorsement of interprofessional clinical education (Table 2 ). Subscale mean scores were similarly high, with learners reporting positive perceptions of Teamwork and Team-Based Practice ( M = 4.22 ± 0.96), Roles and Responsibilities ( M = 4.18 ± 0.86), and Patient Outcomes from Collaborative Practice ( M = 4.12 ± 0.91). Internal Consistency Internal consistency of the SPICE-R instrument was excellent, with a Cronbach’s alpha of 0.97 across the 10 items. Corrected item-total correlations ranged from 0.65 to 0.92, and removal of any individual item did not improve scale reliability, supporting the appropriateness of retaining all items in the total score. Table 1 SPICE-R Post-Session Item Descriptive Statistics (N = 77) Item SPICE-R Item Code Mean SD 1 Working with students from different disciplines enhances my education 4.17 1.02 2 My role within an interprofessional team is clearly defined 4.19 0.95 3 Patient/client satisfaction is improved when care is delivered by an interprofessional team 4.34 0.92 4 Participating in educational experiences with students from different disciplines enhances my ability to work on an interprofessional team 4.17 1.04 5 I have an understanding of the courses taken by, and training requirements of, other health professionals 4.14 0.87 6 Healthcare costs are reduced when patients/clients are treated by an interprofessional team 3.70 1.18 7 Health professional students from different disciplines should be educated to establish collaborative relationships with one another 4.26 0.92 8 I understand the roles of other health professionals within an interprofessional team 4.22 0.94 9 Patient/client-centeredness increases when care is delivered by an interprofessional team 4.33 0.98 10 During their education, health professional students should be involved in teamwork with students from different disciplines in order to understand their respective roles 4.27 1.03 Items were rated on a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree). Table 2 SPICE-R Total and Subscale Scores with Internal Consistency (N = 77) Scale / Subscale No. of Items Mean SD Possible Range Cronbach’s α SPICE-R Total Score 10 41.78 8.77 10–50 0.97 Teamwork & Team-Based Practice 4 4.22 0.96 1–5 — Roles & Responsibilities 3 4.18 0.86 1–5 — Patient Outcomes from Collaboration 3 4.12 0.91 1–5 — Discussion This study demonstrates that a brief, case-based interprofessional education (IPE) session integrating oral health, oral cancer screening, and vaccination content was associated with highly positive learner perceptions of interprofessional collaboration among nursing and dental students. High overall SPICE-R scores and excellent internal reliability suggest that learners perceived value in team-based practice, role awareness, and the contribution of collaboration to patient care, even following a single exposure 17 , 18 . A key contribution of this educational model is its deliberate integration of oral health and vaccination as coequal components of preventive geriatric care. These domains are typically addressed separately within nursing and dental curricula, despite their shared relevance to systemic inflammation and preventable morbidity in older adults. By situating oral hygiene, oral cancer screening, and immunization protocols within a unified geriatric case, the session encouraged learners to conceptualize oral-systemic prevention as a shared responsibility rather than a discipline-specific task. The results are consistent with prior studies demonstrating positive learner perceptions following IPE interventions involving dental, nursing, and other health professions 19 , 20 . Previous work has shown that integrating oral health content into nursing education improves confidence and perceived relevance, and that interprofessional case-based learning enhances understanding of teamwork and collaborative practice 21 – 23 . This study extends that literature by presenting a feasible model that links oral health promotion and vaccination education within a single IPE experience focused on vulnerable older adults. Item-level findings provide important nuance. Although overall endorsement of interprofessional collaboration was high, the lowest-rated item in our dataset was the SPICE-R statement regarding whether healthcare costs are reduced when patients are treated by an interprofessional team. This pattern aligns with item-level findings reported in other SPICE-R/ SPICE-R2 evaluations, where learners tend to endorse clinical and patient-centered benefits of collaboration more strongly than cost-related impact, suggesting that economic outcomes may be less salient or less directly observable to trainees during brief educational experiences 24 , 25 . Unlike patient-centered outcomes, cost reduction is mediated through system-level mechanisms, such as reduced hospitalizations, improved preventive care uptake, and decreased care fragmentation, that may not be immediately apparent to learners in short educational interventions 26 . Integrating brief value-based care discussions may help learners more clearly conceptualize the relationship between interprofessional practice and healthcare costs. From an educational perspective, this model offers several practical advantages. The decision to link vaccination protocols with oral cancer screenings and hygiene is a major strength. It moves the "oral-systemic" conversation beyond the typical diabetes/periodontitis link and addresses holistic geriatric wellness. Furthermore, the flipped-classroom design minimized in-session didactic time and allowed learners to engage actively in application and discussion. Co-facilitation by nursing and dental faculty modeled interprofessional collaboration, and the use of a shared geriatric case provided a realistic context for team-based problem solving. Importantly, the session required minimal additional resources and was embedded within existing coursework, supporting its potential for replication across settings. Limitations This study has several limitations. The evaluation relied on a post-session, self-reported measure of learner perceptions and did not include a pre-session assessment or objective measures of skill acquisition or behavior change. The findings therefore reflect perceived rather than demonstrated competency and cannot be interpreted as evidence of attitudinal change or clinical impact. Additionally, the study was conducted at a single site with a defined group of learners, which may limit generalizability. Implications and Future Directions Despite these limitations, the findings suggest that brief, targeted interprofessional education (IPE) interventions can meaningfully engage learners around oral-systemic preventive care for older adults. Future research should incorporate pre–post designs, longitudinal follow-up, and objective assessments to examine whether such interventions translate into sustained interprofessional behaviors in clinical practice. In addition, given that the lowest-rated outcome related to perceived cost reduction, future curricular iterations may benefit from more explicit attention to the economic implications of interprofessional care. Integrating concrete, system-level examples, such as reduced hospital readmissions through prevention of aspiration pneumonia via improved oral care, may help learners better appreciate the value of interprofessional collaboration beyond clinical and relational outcomes. Expanding this model to include additional professions and clinical settings may further strengthen training for team-based geriatric care. Conclusion A brief interprofessional education (IPE) session integrating oral health and vaccination was associated with strongly positive learner perceptions of teamwork, role clarity, and collaborative practice among nursing and dental students. The feasibility and low-resource nature of this model support its integration into health professions curricula and highlight its potential to strengthen workforce preparedness for team-based, prevention-focused care of older adults. Abbreviations Interprofessional education (IPE) Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) Centers for Disease Control and Prevention (CDC) Interprofessional Education Collaborative (IPEC) Situation, Background, Assessment, Recommendation (SBAR) framework Declarations Ethics approval and consent to participate: This study was submitted to, reviewed by the A.T. Still University-Missouri School of Dentistry and Oral Health Institutional Review Board (ATSU-MOSDOH IRB) and determined to be exempt from full review as an educational evaluation involving anonymous survey data (IRB No. AO20251105-001). Participation in the evaluation was voluntary, and completion of the survey was considered implied informed consent. All responses were collected anonymously and contained no identifiable personal information. All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Consent for publication: Not Applicable Availability of data and materials : De-identified data supporting the findings of this study are available from the corresponding author upon reasonable request. Competing interests : The authors declare that they have no competing interests. Funding Source : This project, “ Addressing Social Determinants of Health and the Oral Health Needs of Vulnerable Populations: A Transformative Approach to Predoctoral Dental Education ,” is supported by the Health Resources & Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $299,334 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. Authors' contributions: AO conceptualized and designed the IPE session, coordinated implementation, conducted the data analysis, and drafted the manuscript. MR, MC and PB contributed to instructional design, facilitated the training session, and reviewed and edited the manuscript. All authors read and approved the final manuscript. Acknowledgments: The authors thank the faculty and students of the Goldfarb School of Nursing at Barnes-Jewish College and A.T. Still University’s Missouri School of Dentistry & Oral Health for their participation and engagement in this interprofessional education initiative. We also acknowledge the faculty facilitators whose collaboration and commitment made the implementation of this session possible. References van der Putten GJ, de Baat C. 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The Impact of Dietary Intake and Nutritional Status on the Oral Health of Older Adults Living in Care Homes: A Scoping Review. Gerodontology . 2025; Pennisi F, Borlini S, Cuciniello R, et al. Improving Vaccine Coverage Among Older Adults and High-Risk Patients: A Systematic Review and Meta-Analysis of Hospital-Based Strategies. MDPI; 2025:1667. Melchinger H, Belgaumi SM, Ahmed N, Omer SB, Malik AA. Change in influenza vaccine uptake among adults in the United States from May 2020 to October 2024. PLOS Glob Public Health . 2025;5(7):e0004756. doi:10.1371/journal.pgph.0004756 Barzoki ER, Fallah S, Marofi S, Talebi M. Evolving aspects of oral care in modern nursing: a systematic review. BMC Oral Health . 2025;25(1):1585. Collaborative. TPC. Innovations in Oral Health and Primary Care Integration: Alignment with the Shared Principles of Primary Care. https://www.pcpcc.org/ resource/innovations-oral-health-and-primary-care-integration-alignment-shared-principles Health CIfO. Transforming Oral Health Care Through Interprofessional Education: A Review and Recommendations (White Paper) . 2025. https://carequest.org/transforming-oral-health-care-through-interprofessional-education/ Collaborative IE. IPEC Core Competencies for Interprofessional Collaborative Practice: Version 3. Washington, DC. Interprofessional Education Collaborative . 2023; Alqutaibi AY, Rahhal MM, Awad R, et al. Foundations of interprofessional education in dental schools: a narrative review. European Journal of Dentistry . 2025; Alqutaibi AY, Rahhal MM, Awad R, et al. Implementing and Evaluating Interprofessional Education for Dental Students: A Narrative Review. Eur J Dent . Mar 13 2025;doi:10.1055/s-0045-1804505 Davis BP, Mitchell SA, Weston J, et al. Situation, Background, Assessment, Recommendation (SBAR) Education for Health Care Students: Assessment of a Training Program. MedEdPORTAL . 2023;19:11293. doi:10.15766/mep_2374-8265.11293 Zorek J, Domínquez D, Fike D, MacLaughlin E. Students Perceptions of Interprofessional Clinical Education Revised (SPICE-R). National Center for Interprofessional Practice and Education November . 2016;30 Zorek JA, MacLaughlin EJ, Fike DS, MacLaughlin AA, Samiuddin M, Young RB. Measuring changes in perception using the student perceptions of physician-pharmacist interprofessional clinical education (SPICE) instrument. BMC medical education . 2014;14(1):101. Brennan LF, McBride A, Akinola M, et al. Improving health professions students’ understanding of interprofessional roles through participation in a patient stabilization simulation. American Journal of Pharmaceutical Education . 2021;85(3):848116. McGregor MR, Lanning SK, Lockeman KS. Dental and dental hygiene student perceptions of interprofessional education. American Dental Hygienists' Association . 2018;92(6):6-15. Al-Ghananeem AM, Palaian S, Kheir N, et al. Impact of an Inaugural Interprofessional Education Session Among Multidisciplinary Healthcare Students: A Mixed Methods Study from the United Arab Emirates. J Multidiscip Healthc . 2025;18:7007-7024. doi:10.2147/jmdh.S550623 Haresaku S, Naito T, Aoki H, et al. Development of interprofessional education programmes in nursing care and oral healthcare for dental and nursing students. BMC Med Educ . Apr 8 2024;24(1):381. doi:10.1186/s12909-024-05227-2 Nash WA, Hall LA, Ridner SL, et al. Evaluation of an interprofessional education program for advanced practice nursing and dental students: the oral-systemic health connection. Nurse Education Today . 2018;66:25-32. Haber J, Spielman AI, Wolff M, Shelley D. Interprofessional education between dentistry and nursing: the NYU experience. Journal of the California Dental Association . 2014;42(1):44-51. Pence J, Ashe S, Adunlin G, Beall J. A Comparison of Nursing and Pharmacy Students’ Perceptions of an Acute Care Simulation. MDPI; 2022:715. Yilmaz S, Hahn M, Roll SC, Muth C, van den Akker M. A short elective supports the attitudes of medicine and pharmacy students towards interprofessional learning: a pre-post design. BMC Medical Education . 2025;25(1):393. Teisberg E, Wallace S, O’Hara S. Defining and implementing value-based health care: a strategic framework. Academic Medicine . 2020;95(5):682-685. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9084945","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":629776011,"identity":"6f3d1a26-15a3-4043-b906-215db935f446","order_by":0,"name":"Abimbola Oladayo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYDACCcYGZgYGCwYGdiAbyJeDijMT0iIBVgPSYszARlALTDFUS2IDIS38s5tbNxdUSMjzMzM/vPGzzSa9f377MwmGCuvEBlyW3DnYdnvGGQnDmc1sxpa9bWm5M47xmEkwnEnHqYXhRmLbbd42CcYNhxnMJHjbDuc2HONhk2BsO4xTizxUi/2Gw+zfJP+2HU6XP8b+TILxH24tBlAtiRsO85hJA21JMDgGtI6xAbcWQ6hfkmc28xRby5xLM9x4LMfYIuFYujEuLXK325/dLqiwse1nb994802Zjbzc4eMPb3yosZbF6X0UwMgGZSQQpRwM/hCvdBSMglEwCkYOAABxnFqnyki2xQAAAABJRU5ErkJggg==","orcid":"","institution":"A.T. 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Still University","correspondingAuthor":false,"prefix":"","firstName":"Hanan","middleName":"","lastName":"Omar","suffix":""}],"badges":[],"createdAt":"2026-03-10 14:08:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9084945/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9084945/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108182283,"identity":"dad3674b-ed1c-4696-9e57-822bbb1d9cb8","added_by":"auto","created_at":"2026-04-30 08:59:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":240845,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9084945/v1/d6ab21f4-c553-4427-bf2c-5dee382bfdeb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Interprofessional Education for Oral-Systemic Health Management in Vulnerable Older Adults: A Collaborative Approach Between Dental and Nursing Students","fulltext":[{"header":"Background","content":"\u003cp\u003eOral and systemic health are deeply interconnected, particularly in aging populations, who often experience polypharmacy-associated xerostomia, periodontal disease, denture-related complications, and functional limitations that compromise oral hygiene \u003csup\u003e1-4\u003c/sup\u003e. These conditions contribute to adverse systemic outcomes, including malnutrition, systemic inflammation, and aspiration pneumonia, one of the leading causes of morbidity and mortality in long-term care settings \u003csup\u003e5,6\u003c/sup\u003e. At the same time, vaccination uptake among older adults remains suboptimal despite established Centers for Disease Control and Prevention (CDC) recommendations for influenza, pneumococcal, COVID-19, and herpes zoster immunizations \u003csup\u003e7,8\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eNurses frequently provide daily oral care assistance, health education, and vaccination counseling in clinical and community settings, while dentists play a central role in identifying oral pathology and oral-systemic risk factors. Despite these complementary responsibilities, nursing and dental education have historically addressed oral health, vaccination, and preventive care in parallel rather than collaboratively \u003csup\u003e9\u003c/sup\u003e. As a result, nurses may feel underprepared to conduct oral assessments or make timely dental referrals, and dental trainees may have limited exposure to vaccination protocols or interprofessional care coordination for medically complex older adults.\u003c/p\u003e\n\u003cp\u003eInterprofessional education (IPE) has been widely promoted as a strategy to address such fragmentation\u003csup\u003e10,11\u003c/sup\u003e. The Interprofessional Education Collaborative (IPEC) identifies core competencies-including shared values and ethics, role clarification, interprofessional communication, and teamwork-as essential for preparing a collaborative-ready health workforce \u003csup\u003e12\u003c/sup\u003e. Prior studies have demonstrated the benefits of integrating oral health content into nursing, medical, and allied health curricula, as well as the positive impact of IPE on learner perceptions of teamwork and collaborative practice \u003csup\u003e13,14\u003c/sup\u003e. However, few published educational models have intentionally integrated oral health promotion, oral cancer screening, and vaccination education as coequal components of preventive geriatric care within a single interprofessional learning experience. To address this gap, we designed and implemented a joint nursing-dental IPE session focused on oral-systemic integration in the care of older adults. The session emphasized preventive oral health practices, oral cancer screening, vaccination protocols, and interprofessional case management using a shared geriatric scenario.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy aim\u003c/strong\u003e: The purpose of this study was to describe the development and implementation of this IPE model and to evaluate learners’ post-session perceptions of interprofessional teamwork and collaborative practice using the validated Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) instrument.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design:\u0026nbsp;\u003c/strong\u003eThis study employed a post-test-only quantitative design to evaluate a single-session interprofessional education (IPE) activity focused on oral-systemic preventive care for older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting and Participants:\u0026nbsp;\u003c/strong\u003eThe IPE session was conducted jointly between the Goldfarb School of Nursing and A.T. Still University’s Missouri School of Dentistry \u0026amp; Oral Health (MOSDOH). Faculty facilitators represented both disciplines. A total of 77 learners (73 dental students and 4 graduate nursing students) participated as part of their required curricular interprofessional training.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudent Learning Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBy the end of the session, learners were expected to:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eDemonstrate safe and effective preventive oral health practices for older adults, including adaptive strategies and opportunistic oral cancer screening.\u003c/li\u003e\n \u003cli\u003eApply current CDC adult vaccination guidelines and demonstrate appropriate vaccination techniques in accordance with safety protocols.\u003c/li\u003e\n \u003cli\u003eDevelop an integrated, team-based preventive care plan addressing oral health, vaccination, and relevant social determinants of health.\u003c/li\u003e\n \u003cli\u003eCollaborate and communicate effectively across disciplines to support coordinated care for medically complex older adults.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eTo support achievement of these outcomes, the session was structured using a flipped-classroom model that combined pre-session preparation with interactive, case-based learning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstructional Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to the in-person session, learners completed two required pre-work activities: (1) a 9-minute instructional video, Oral Health Care in Older Adults, addressing daily oral hygiene adaptations, xerostomia management, denture care, and opportunistic oral cancer screening; and (2) review of the Centers for Disease Control and Prevention (CDC) adult immunization schedule and vaccination recommendations relevant to older adults. Learners were asked to reflect on one new connection between oral health and vaccination in preventive geriatric care. The in-person session lasted 2 hours and consisted of four components:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eIntroduction (5 minutes)\u003c/strong\u003e: Overview of session objectives and the importance of interprofessional collaboration in oral-systemic geriatric care.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVaccination Module (45 minutes)\u003c/strong\u003e: Instruction on CDC vaccination guidelines, the “7 Rights” of vaccine administration, intramuscular and subcutaneous injection techniques, safety considerations, and documentation requirements.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eOral Health Module (45 minutes):\u003c/strong\u003e Demonstrations and discussion focused on daily oral hygiene for older adults, xerostomia management, denture care, opportunistic oral cancer screening, and aspiration pneumonia risk reduction.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCase-Based Interprofessional Activity (20 minutes):\u003c/strong\u003e Learners worked in mixed nursing-dental teams on a shared geriatric case about a 68-year-old individual with chronic obstructive pulmonary disease, diabetes, xerostomia, poor dentition, and a recent episode of aspiration pneumonia. Using the SBAR (Situation, Background, Assessment, Recommendation) framework, teams developed a shared care plan addressing oral hygiene strategy, vaccination needs, referral pathways, and relevant social determinants of health, and practiced a brief interprofessional handoff \u003csup\u003e15\u003c/sup\u003e.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eEvaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLearner perceptions of interprofessional collaboration were assessed using the Students’ Perceptions of Interprofessional Clinical Education–Revised (SPICE-R) instrument \u003csup\u003e16\u003c/sup\u003e. SPICE-R is a validated 10-item questionnaire scored on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) and includes three subscales:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eTeamwork and Team-Based Practice (Items 1,4,7,10)\u003c/li\u003e\n \u003cli\u003eRoles and Responsibilities for Collaborative Practice (Items 2,5,8)\u003c/li\u003e\n \u003cli\u003ePatient Outcomes from Collaborative Practice (Items 3,6,9)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurvey data were collected via Qualtrics and exported for analysis. Likert-scale responses were mapped to numeric values (1–5). Descriptive statistics (means, standard deviations, ranges, and frequencies) were calculated for individual items, subscales, and the total SPICE-R score (range 10–50). Internal consistency was assessed using Cronbach’s alpha. Analyses were conducted using SPSS version 30. No inferential pre-post comparisons were performed, as no baseline survey was administered.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Completion\u003c/h2\u003e \u003cp\u003eAll 77 learners who participated in the interprofessional education (IPE) session completed the post-session SPICE-R survey, yielding a 100% response rate. No cases were excluded from the analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eItem-Level SPICE-R Findings\u003c/h2\u003e \u003cp\u003eItem-level descriptive statistics demonstrated consistently favorable perceptions of interprofessional collaboration across all SPICE-R items (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Mean item scores ranged from 3.70 to 4.34 on the 5-point Likert scale. The highest mean scores were observed for items reflecting perceived benefits of teamwork for understanding clinical problems and improving patient care (Q2_3, Q2_9, Q2_10). The lowest mean score was observed for the item assessing perceptions of cost reduction associated with interprofessional care (Q2_6; \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.70, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.18), suggesting greater uncertainty about the economic impact of team-based care relative to its perceived clinical benefits. All items demonstrated the full response range (1\u0026ndash;5), suggesting adequate variability and engagement.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTotal and Subscale Scores\u003c/h3\u003e\n\u003cp\u003eThe mean total SPICE-R score was 41.78\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77 (possible range: 10\u0026ndash;50), indicating strong overall endorsement of interprofessional clinical education (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Subscale mean scores were similarly high, with learners reporting positive perceptions of Teamwork and Team-Based Practice (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96), Roles and Responsibilities (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86), and Patient Outcomes from Collaborative Practice (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91).\u003c/p\u003e\n\u003ch3\u003eInternal Consistency\u003c/h3\u003e\n\u003cp\u003eInternal consistency of the SPICE-R instrument was excellent, with a Cronbach\u0026rsquo;s alpha of 0.97 across the 10 items. Corrected item-total correlations ranged from 0.65 to 0.92, and removal of any individual item did not improve scale reliability, supporting the appropriateness of retaining all items in the total score.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSPICE-R Post-Session Item Descriptive Statistics (N\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSPICE-R Item Code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorking with students from different disciplines enhances my education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMy role within an interprofessional team is clearly defined\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient/client satisfaction is improved when care is delivered by an interprofessional team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipating in educational experiences with students from different disciplines enhances my ability to work on an interprofessional team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI have an understanding of the courses taken by, and training requirements of, other health professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthcare costs are reduced when patients/clients are treated by an interprofessional team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth professional students from different disciplines should be educated to establish collaborative relationships with one another\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI understand the roles of other health professionals within an interprofessional team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient/client-centeredness increases when care is delivered by an interprofessional team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring their education, health professional students should be involved in teamwork with students from different disciplines in order to understand their respective roles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eItems were rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;Strongly Disagree, 5\u0026thinsp;=\u0026thinsp;Strongly Agree).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSPICE-R Total and Subscale Scores with Internal Consistency (N\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScale / Subscale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePossible Range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCronbach\u0026rsquo;s α\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSPICE-R Total Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeamwork \u0026amp; Team-Based Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoles \u0026amp; Responsibilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Outcomes from Collaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates that a brief, case-based interprofessional education (IPE) session integrating oral health, oral cancer screening, and vaccination content was associated with highly positive learner perceptions of interprofessional collaboration among nursing and dental students. High overall SPICE-R scores and excellent internal reliability suggest that learners perceived value in team-based practice, role awareness, and the contribution of collaboration to patient care, even following a single exposure \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA key contribution of this educational model is its deliberate integration of oral health and vaccination as coequal components of preventive geriatric care. These domains are typically addressed separately within nursing and dental curricula, despite their shared relevance to systemic inflammation and preventable morbidity in older adults. By situating oral hygiene, oral cancer screening, and immunization protocols within a unified geriatric case, the session encouraged learners to conceptualize oral-systemic prevention as a shared responsibility rather than a discipline-specific task.\u003c/p\u003e \u003cp\u003eThe results are consistent with prior studies demonstrating positive learner perceptions following IPE interventions involving dental, nursing, and other health professions\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Previous work has shown that integrating oral health content into nursing education improves confidence and perceived relevance, and that interprofessional case-based learning enhances understanding of teamwork and collaborative practice \u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. This study extends that literature by presenting a feasible model that links oral health promotion and vaccination education within a single IPE experience focused on vulnerable older adults.\u003c/p\u003e \u003cp\u003eItem-level findings provide important nuance. Although overall endorsement of interprofessional collaboration was high, the lowest-rated item in our dataset was the SPICE-R statement regarding whether healthcare costs are reduced when patients are treated by an interprofessional team. This pattern aligns with item-level findings reported in other SPICE-R/ SPICE-R2 evaluations, where learners tend to endorse clinical and patient-centered benefits of collaboration more strongly than cost-related impact, suggesting that economic outcomes may be less salient or less directly observable to trainees during brief educational experiences\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Unlike patient-centered outcomes, cost reduction is mediated through system-level mechanisms, such as reduced hospitalizations, improved preventive care uptake, and decreased care fragmentation, that may not be immediately apparent to learners in short educational interventions\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Integrating brief value-based care discussions may help learners more clearly conceptualize the relationship between interprofessional practice and healthcare costs.\u003c/p\u003e \u003cp\u003eFrom an educational perspective, this model offers several practical advantages. The decision to link vaccination protocols with oral cancer screenings and hygiene is a major strength. It moves the \"oral-systemic\" conversation beyond the typical diabetes/periodontitis link and addresses holistic geriatric wellness. Furthermore, the flipped-classroom design minimized in-session didactic time and allowed learners to engage actively in application and discussion. Co-facilitation by nursing and dental faculty modeled interprofessional collaboration, and the use of a shared geriatric case provided a realistic context for team-based problem solving. Importantly, the session required minimal additional resources and was embedded within existing coursework, supporting its potential for replication across settings.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. The evaluation relied on a post-session, self-reported measure of learner perceptions and did not include a pre-session assessment or objective measures of skill acquisition or behavior change. The findings therefore reflect perceived rather than demonstrated competency and cannot be interpreted as evidence of attitudinal change or clinical impact. Additionally, the study was conducted at a single site with a defined group of learners, which may limit generalizability.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eImplications and Future Directions\u003c/h2\u003e \u003cp\u003eDespite these limitations, the findings suggest that brief, targeted interprofessional education (IPE) interventions can meaningfully engage learners around oral-systemic preventive care for older adults. Future research should incorporate pre\u0026ndash;post designs, longitudinal follow-up, and objective assessments to examine whether such interventions translate into sustained interprofessional behaviors in clinical practice. In addition, given that the lowest-rated outcome related to perceived cost reduction, future curricular iterations may benefit from more explicit attention to the economic implications of interprofessional care. Integrating concrete, system-level examples, such as reduced hospital readmissions through prevention of aspiration pneumonia via improved oral care, may help learners better appreciate the value of interprofessional collaboration beyond clinical and relational outcomes. Expanding this model to include additional professions and clinical settings may further strengthen training for team-based geriatric care.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA brief interprofessional education (IPE) session integrating oral health and vaccination was associated with strongly positive learner perceptions of teamwork, role clarity, and collaborative practice among nursing and dental students. The feasibility and low-resource nature of this model support its integration into health professions curricula and highlight its potential to strengthen workforce preparedness for team-based, prevention-focused care of older adults.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n \u003cli\u003eInterprofessional education (IPE)\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eStudent Perceptions of Interprofessional Clinical Education-Revised (SPICE-R)\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCenters for Disease Control and Prevention (CDC)\u003c/li\u003e\n \u003cli\u003eInterprofessional Education Collaborative (IPEC)\u003c/li\u003e\n \u003cli\u003eSituation, Background, Assessment, Recommendation (SBAR) framework\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was submitted to, reviewed by the A.T. Still University-Missouri School of Dentistry and Oral Health Institutional Review Board (ATSU-MOSDOH IRB) and determined to be exempt from full review as an educational evaluation involving anonymous survey data (IRB No. AO20251105-001). Participation in the evaluation was voluntary, and completion of the survey was considered implied informed consent. All responses were collected anonymously and contained no identifiable personal information. All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: De-identified data supporting the findings of this study are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Source\u003c/strong\u003e: This project, “\u003cem\u003eAddressing Social Determinants of Health and the Oral Health Needs of Vulnerable Populations: A Transformative Approach to Predoctoral Dental Education\u003c/em\u003e,” is supported by the Health Resources \u0026amp; Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $299,334 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003eAO conceptualized and designed the IPE session, coordinated implementation, conducted the data analysis, and drafted the manuscript. MR, MC and PB contributed to instructional design, facilitated the training session, and reviewed and edited the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThe authors thank the faculty and students of the Goldfarb School of Nursing at Barnes-Jewish College and A.T. Still University’s Missouri School of Dentistry \u0026amp; Oral Health for their participation and engagement in this interprofessional education initiative. We also acknowledge the faculty facilitators whose collaboration and commitment made the implementation of this session possible.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003evan der Putten GJ, de Baat C. An Overview of Systemic Health Factors Related to Rapid Oral Health Deterioration among Older People. \u003cem\u003eJ Clin Med\u003c/em\u003e. Jun 27 2023;12(13)doi:10.3390/jcm12134306\u003c/li\u003e\n \u003cli\u003eLowenstein A, Singh ML, Papas AS. Addressing disparities in oral health access and outcomes for aging adults in the United States. \u003cem\u003eFrontiers in Dental Medicine\u003c/em\u003e. 2025;6:1522892.\u003c/li\u003e\n \u003cli\u003eBolukbasi G, Dundar N. Oral health in older adults: current insights and tips. \u003cem\u003eJournal of Gerontology and Geriatrics\u003c/em\u003e. 2024;72:96-107.\u003c/li\u003e\n \u003cli\u003eGil-Montoya JA, de Mello AL, Barrios R, Gonzalez-Moles MA, Bravo M. Oral health in the elderly patient and its impact on general well-being: a nonsystematic review. \u003cem\u003eClin Interv Aging\u003c/em\u003e. 2015;10:461-7. doi:10.2147/cia.S54630\u003c/li\u003e\n \u003cli\u003eDesai JP, Nair RU. Oral Health Factors Related to Rapid Oral Health Deterioration among Older Adults: A Narrative Review. \u003cem\u003eJ Clin Med\u003c/em\u003e. Apr 29 2023;12(9)doi:10.3390/jcm12093202\u003c/li\u003e\n \u003cli\u003eSallam A, McCorry NK, Harvey M, et al. The Impact of Dietary Intake and Nutritional Status on the Oral Health of Older Adults Living in Care Homes: A Scoping Review. \u003cem\u003eGerodontology\u003c/em\u003e. 2025;\u003c/li\u003e\n \u003cli\u003ePennisi F, Borlini S, Cuciniello R, et al. Improving Vaccine Coverage Among Older Adults and High-Risk Patients: A Systematic Review and Meta-Analysis of Hospital-Based Strategies. MDPI; 2025:1667.\u003c/li\u003e\n \u003cli\u003eMelchinger H, Belgaumi SM, Ahmed N, Omer SB, Malik AA. Change in influenza vaccine uptake among adults in the United States from May 2020 to October 2024. \u003cem\u003ePLOS Glob Public Health\u003c/em\u003e. 2025;5(7):e0004756. doi:10.1371/journal.pgph.0004756\u003c/li\u003e\n \u003cli\u003eBarzoki ER, Fallah S, Marofi S, Talebi M. Evolving aspects of oral care in modern nursing: a systematic review. \u003cem\u003eBMC Oral Health\u003c/em\u003e. 2025;25(1):1585.\u003c/li\u003e\n \u003cli\u003eCollaborative. TPC. Innovations in Oral Health and Primary Care Integration: Alignment with the Shared Principles of Primary Care. https://www.pcpcc.org/ resource/innovations-oral-health-and-primary-care-integration-alignment-shared-principles\u003c/li\u003e\n \u003cli\u003eHealth CIfO. \u003cem\u003eTransforming Oral Health Care Through Interprofessional Education: A Review and Recommendations (White Paper)\u003c/em\u003e. 2025. https://carequest.org/transforming-oral-health-care-through-interprofessional-education/\u003c/li\u003e\n \u003cli\u003eCollaborative IE. IPEC Core Competencies for Interprofessional Collaborative Practice: Version 3. Washington, DC. \u003cem\u003eInterprofessional Education Collaborative\u003c/em\u003e. 2023;\u003c/li\u003e\n \u003cli\u003eAlqutaibi AY, Rahhal MM, Awad R, et al. Foundations of interprofessional education in dental schools: a narrative review. \u003cem\u003eEuropean Journal of Dentistry\u003c/em\u003e. 2025;\u003c/li\u003e\n \u003cli\u003eAlqutaibi AY, Rahhal MM, Awad R, et al. Implementing and Evaluating Interprofessional Education for Dental Students: A Narrative Review. \u003cem\u003eEur J Dent\u003c/em\u003e. Mar 13 2025;doi:10.1055/s-0045-1804505\u003c/li\u003e\n \u003cli\u003eDavis BP, Mitchell SA, Weston J, et al. Situation, Background, Assessment, Recommendation (SBAR) Education for Health Care Students: Assessment of a Training Program. \u003cem\u003eMedEdPORTAL\u003c/em\u003e. 2023;19:11293. doi:10.15766/mep_2374-8265.11293\u003c/li\u003e\n \u003cli\u003eZorek J, Dom\u0026iacute;nquez D, Fike D, MacLaughlin E. Students Perceptions of Interprofessional Clinical Education Revised (SPICE-R). \u003cem\u003eNational Center for Interprofessional Practice and Education November\u003c/em\u003e. 2016;30\u003c/li\u003e\n \u003cli\u003eZorek JA, MacLaughlin EJ, Fike DS, MacLaughlin AA, Samiuddin M, Young RB. Measuring changes in perception using the student perceptions of physician-pharmacist interprofessional clinical education (SPICE) instrument. \u003cem\u003eBMC medical education\u003c/em\u003e. 2014;14(1):101.\u003c/li\u003e\n \u003cli\u003eBrennan LF, McBride A, Akinola M, et al. Improving health professions students\u0026rsquo; understanding of interprofessional roles through participation in a patient stabilization simulation. \u003cem\u003eAmerican Journal of Pharmaceutical Education\u003c/em\u003e. 2021;85(3):848116.\u003c/li\u003e\n \u003cli\u003eMcGregor MR, Lanning SK, Lockeman KS. Dental and dental hygiene student perceptions of interprofessional education. \u003cem\u003eAmerican Dental Hygienists\u0026apos; Association\u003c/em\u003e. 2018;92(6):6-15.\u003c/li\u003e\n \u003cli\u003eAl-Ghananeem AM, Palaian S, Kheir N, et al. Impact of an Inaugural Interprofessional Education Session Among Multidisciplinary Healthcare Students: A Mixed Methods Study from the United Arab Emirates. \u003cem\u003eJ Multidiscip Healthc\u003c/em\u003e. 2025;18:7007-7024. doi:10.2147/jmdh.S550623\u003c/li\u003e\n \u003cli\u003eHaresaku S, Naito T, Aoki H, et al. Development of interprofessional education programmes in nursing care and oral healthcare for dental and nursing students. \u003cem\u003eBMC Med Educ\u003c/em\u003e. Apr 8 2024;24(1):381. doi:10.1186/s12909-024-05227-2\u003c/li\u003e\n \u003cli\u003eNash WA, Hall LA, Ridner SL, et al. Evaluation of an interprofessional education program for advanced practice nursing and dental students: the oral-systemic health connection. \u003cem\u003eNurse Education Today\u003c/em\u003e. 2018;66:25-32.\u003c/li\u003e\n \u003cli\u003eHaber J, Spielman AI, Wolff M, Shelley D. Interprofessional education between dentistry and nursing: the NYU experience. \u003cem\u003eJournal of the California Dental Association\u003c/em\u003e. 2014;42(1):44-51.\u003c/li\u003e\n \u003cli\u003ePence J, Ashe S, Adunlin G, Beall J. A Comparison of Nursing and Pharmacy Students\u0026rsquo; Perceptions of an Acute Care Simulation. MDPI; 2022:715.\u003c/li\u003e\n \u003cli\u003eYilmaz S, Hahn M, Roll SC, Muth C, van den Akker M. A short elective supports the attitudes of medicine and pharmacy students towards interprofessional learning: a pre-post design. \u003cem\u003eBMC Medical Education\u003c/em\u003e. 2025;25(1):393.\u003c/li\u003e\n \u003cli\u003eTeisberg E, Wallace S, O\u0026rsquo;Hara S. Defining and implementing value-based health care: a strategic framework. \u003cem\u003eAcademic Medicine\u003c/em\u003e. 2020;95(5):682-685.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Interprofessional education, oral health, vaccination, oral cancer screening, older adults, SPICE-R, collaborative practice","lastPublishedDoi":"10.21203/rs.3.rs-9084945/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9084945/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The oral-systemic connection is a critical yet under-addressed component of geriatric care, despite the high burden of oral disease and preventable morbidity among older adults. Interprofessional education (IPE) offers a strategy to strengthen team-based communication, clarify professional roles, and support collaborative preventive care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eTo describe the development and implementation of a joint nursing-dental IPE session integrating geriatric oral health, oral cancer screening, and vaccination content, and to evaluate students’ post-session perceptions of interprofessional collaboration using the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) instrument.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A 2-hour, case-based IPE session was delivered to nursing and dental students from two institutions using a flipped-classroom model with pre-work, skills-based instruction, and interprofessional case planning. Learner perceptions were assessed post-session using the validated 10-item SPICE-R instrument. Descriptive statistics summarized responses, and internal consistency was measuring using Cronbach’s alpha.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSeventy-seven learners completed the post-session survey. Mean item scores ranged from 3.70 to 4.34 on a 5-point Likert scale. The mean total SPICE-R score was 41.78 ± 8.77. Subscale mean scores were 4.22 ± 0.96 for Teamwork and Team-Based Practice, 4.18 ± 0.86 for Roles and Responsibilities, and 4.12 ± 0.91 for Patient Outcomes from Collaborative Practice. Internal consistency was excellent (α = 0.97).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: This brief interprofessional education (IPE) intervention was associated with positive perceptions of teamwork and role clarity and offers a feasible, replicable approach for integrating oral-systemic care into nursing and dental curricula.\u003c/p\u003e","manuscriptTitle":"Interprofessional Education for Oral-Systemic Health Management in Vulnerable Older Adults: A Collaborative Approach Between Dental and Nursing Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-29 08:37:25","doi":"10.21203/rs.3.rs-9084945/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-18T09:43:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T22:48:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127485937163064899546492699803597648205","date":"2026-05-09T13:40:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T02:34:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188433221710640159749604484721600923559","date":"2026-05-09T02:09:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-06T14:03:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220364897791744459649775035443769181629","date":"2026-05-05T07:15:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-02T01:26:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86215935183003087002947544552792644177","date":"2026-04-26T14:54:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"193984100671278326597806664890119285559","date":"2026-04-24T00:59:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75559631106429961530876754961490862900","date":"2026-04-21T13:21:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T12:33:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-27T11:25:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-24T12:27:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-24T06:17:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-24T05:32:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fae973b7-608c-4ee0-8090-e72a3f142cb7","owner":[],"postedDate":"April 29th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-18T09:43:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T22:48:37+00:00","index":86,"fulltext":""},{"type":"reviewerAgreed","content":"127485937163064899546492699803597648205","date":"2026-05-09T13:40:43+00:00","index":82,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T02:34:16+00:00","index":81,"fulltext":""},{"type":"reviewerAgreed","content":"188433221710640159749604484721600923559","date":"2026-05-09T02:09:04+00:00","index":80,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-06T14:03:21+00:00","index":79,"fulltext":""},{"type":"reviewerAgreed","content":"220364897791744459649775035443769181629","date":"2026-05-05T07:15:47+00:00","index":77,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-02T01:26:50+00:00","index":58,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T09:54:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-29 08:37:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9084945","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9084945","identity":"rs-9084945","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}