Emergence from COVID-19: The University of Pittsburgh School of Dental Medicine

The University of Pittsburgh School of Dental Medicine met one of the most unique challenges in its history with COVID-19.

Little did we know back in February that a pandemic would be something that would challenge our infrastructure and creativity to try to find our way to success. By Friday, March 13, 2020 it was determined that all programs needed to go online for lecture courses and suspend all in-house clinical operations in favor of telehealth, until much more was known about the threat of the virus. Thankfully, we were able to continue emergency care via our UPMC facilities and quickly worked with the PA Dental Coalition to help reverse decisions regarding negative pressure restrictions imposed on dentists all over the Commonwealth; this allowed us to get back to urgent care quickly, and the School of Dental Medicine was the only building open at the University of Pittsburgh for a number of months. By mid-March, all didactic classes at the school and our telehealth operations were remote using online platforms such as Zoom. Fortunately, many of our courses were recorded as per our pre-pandemic policy and this made the transition much easier. It quite literally took just several days to be able to convert our activities to completely online learning for most of our curriculum, other than hands-on patient care.

A robust faculty-driven telehealth platform was developed quickly to address patients presenting with urgent and emergent oral health needs and any questions. This allowed in-school telemedicine to be an emergency and triage resource for the entire region. This also assisted our overtaxed medical center emergency room capabilities with all of the concerns regarding COVID-19 at their own doorsteps. One of the first calls we received was from the UPMC leadership in an attempt to make sure that we would not stop dental services as they know how critical they are to the public health everywhere. If dentistry did not contribute, they would be overwhelmed. They see this first-hand that when the services are not available, particularly for those most at risk economically, people suffer and disease progresses. We were able to keep these services going for our communities and for our health partners at medical centers all over the Commonwealth through the entire pandemic, 24/7.

We also pivoted our patient service activities and revised staff capabilities to a work-from-home location by transferring phone calls, enabling verbal COVID and disease screening, scheduling appointments, processing payments, obtaining consent, and completion of all pre-procedure data intake. On-site infection control protocols and revised workflows were developed and implemented to treat patients presenting with emergency dental needs by faculty initially. As we became more comfortable with these workflows in the first several weeks, our residents and ultimately students from the pre-doctoral program were able to contribute to the care of our patients using high level risk mitigation strategies and enhanced PPE at the organizational level as well as for the individual practitioner.

The School of Dental Medicine was also able to shift some clinical competency work to online simulated cases to complete some of the remaining competency examinations that did not require hands-on work or to be facilitated with simulation. Faculty in each discipline met one-on-one with students to review complex cases and discuss treatment, review critical concepts, and simulate the case. Pre-empting this educational process allowed us to move faster once we returned to the clinic with our students in early June. This allowed all pre-doctoral students in the class of 2020 to graduate on time with their requirements and competencies completed, which required an incredible amount of teamwork by our faculty, staff, administrators, and our students.

The dental hygiene program followed a similar approach, as did the residencies, which were modified to allow for synchronous and asynchronous learning for not only our institution but many institutions that collaborated and contributed to online learning platforms to share educational experiences and lectures. New collaborators and new networks were developed to help others as well as our programs. Throughout our curriculum we modified coursework as needed to allow for the anticipated schedule changes that would follow, as we emerged from COVID restrictions. Knowing that on-site care would be delayed in some way, some courses typically taught later in the year we moved online earlier in anticipation of the need to free up time for students to experience pre-clinical work and clinical care, once at least some restrictions were lifted.

By the end of May, preparations to mitigate risk were made to assume a broader on-site presence that included residents and students in all departments. This was achieved by adopting the National Institute for Occupational Safety and Health‘s method of risk reduction as a prevention through design strategy. This method notes the interventions at the top of the pyramid to have the greatest impact via elimination of risk while interventions at the bottom of the pyramid are recognized as least effective in mitigating strategies, such as use of PPE. While all are affective, we used a hierarchy of controls to do the best we could with these challenges. Some of the techniques included working remotely when individuals were able, teaching remotely, holding meetings virtually, staggering shifts, maximizing airflow and exchanges, restricting access of individuals from the facility to de-densify, practicing social distancing and wearing masks, avoiding aerosol generating procedures when appropriate, decluttering patient care and common areas, and following all guidelines provided via the Pennsylvania Department of Health, CDC, OSHA, and others. We also worked with our partners at UPMC to understand emerging data from our analytics team and further refine these processes and protocols so that they would be as effective as possible. Active partnership was a key part of our success. We learned from others, and others learned from us.

By early June, students and residents began returning to our facility more regularly in pre-clinical courses. We also began offering educational experiences in small cohorts to make up for lost spring and early summer content. Third year students came on site and in small cohorts to practice their skills and do this in simulation environments. By July, they were beginning to assist with patient care and resume care of their assigned patients. Throughout the summer, all missed spring and summer pre-clinical and lecture content were completed and the students were treating patients all across our clinics at somewhere between 50 to 65% of our pre-COVID volumes. We were working to overcome the backlog and beginning to facilitate success for our enterprise again. At the same time, we were filling a critical need for the community.

At the end of August, the fall term recently began as a hybrid with both faculty and students given the choice to be virtual or in person for many offerings. Some evening pre-clinical labs were scheduled to allow for social distancing while utilizing PPE for additional protection. Early clinical experiences for students continued, and the first- and second-year students began engaging with their teams to provide assistance with patient care and begin to understand the early aspects of treating patients. One of our most exciting moments occurred in late August as we welcomed our new first-year students, and began integrating them into didactic coursework, pre-clinical care, and some beginning clinical experiences. They have quickly learned to understand how dentistry is in the lead with infection control and universal precautions compared to many other sectors inside and outside of healthcare. Additionally, the University of Pittsburgh and the School of Dental Medicine partnered to install state-of-the-art classroom technology which included additional extra-wide monitors, 4K monitors, superior-quality audio equipment, and other technology that allowed for much better interaction for our online experiences.

Throughout it all, we have taken the position that not only were we going to overcome these challenges from a logistical standpoint, but that we would try our hardest throughout this difficulty time to find not just the silver linings but the real opportunities to grow and improve. The University of Pittsburgh School Dental Medicine still has many challenges to overcome, including the increased financial challenges that will be with us for some time. We are committed to providing the best experience possible at one of the finest institutions that affords world-class educational experiences in oral health and craniofacial care. Additionally, this experience has shown the people at our institution the importance of teamwork. Collaboration is not just critical in our own organization, but with partners across the region inside and outside of dentistry. The synergy and teamwork have been inspiring and has taught us all how to work together even better. Our team worked very hard to get through this, and we will continue to emerge stronger than before. The University of Pittsburgh School of Dental Medicine is grateful to all those who collaborated, helped, and collectively allowed us all to move forward.