School Adapts Immediately to COVID-19 Pandemic
By Catherine Duncan
For the School of Dentistry, the concerns started off fairly innocuously. Would this novel coronavirus affecting other parts of the world have any impact in San Antonio, Texas? The initial concern focused on patients who had recently traveled abroad and students and employees who were travelling during spring break March 16 through 20. Would the school allow them to return to campus?
Adriana Segura, D.D.S., M.S., associate dean for academic, faculty and student affairs, said the academic team quickly determined the issue of returning students was a moot point. Because of the COVID-19 pandemic, no students would be returning to campus in the spring of 2020. The dental school leadership team had days to figure out how to offer all classes and, more importantly, all tests virtually.
With assistance from Dana English, Ed.D., M.S., RDH, assistant dean for education and faculty development, and Jason Sandlin, distributed education coordinator, Dr. Segura performed an in-depth evaluation of all coursework. With input from course directors, they studied course syllabi, schedules and technological opportunities to ensure all classes could continue. The three worked with faculty members who needed assistance adapting their courses so they could move entirely online.
“We had to switch to using Canvas Conferences. Not all of our faculty were familiar with this feature in Canvas,” Dr. Segura said. Canvas has been used for housing syllabi and course information. Canvas Conferences is an online learning management platform that supports a school’s online learning and teaching. Conferences is a place within Canvas that allows students and faculty to come together online for virtual classes with real-time audio and video and the sharing of presentation slides.
Dr. Segura said they worked with faculty members to present the lectures in Conferences at the same time the classes would have been meeting. “We really wanted to keep our students engaged during this unusual time,” she said.
The most challenging aspect of moving to virtual academia was not being able to give exams on campus, she said. “We had to use ExamID and ExamMonitor so we could monitor students while they took exams. Jason assisted students with acquiring a facial recognition image for testing. He ran mock exams to make sure there would be no problems when students were taking critical exams. Jason virtually sat in on every exam to make sure everything went smoothly,” she explained.
One part of their education that students couldn’t do from home was practicing clinical skills in the simulation labs. The team started making plans in April and were able to get the fourth-year students (now recent graduates) in the lab the first week of July so they could practice their clinical skills before their delayed board exams July 8. The school hosted a practice session the week before the board exams since the fourth-year students hadn’t been working on patients, she said. Dental students had a 97 percent pass rate while dental hygiene students achieved 100 percent.
In June, the second and third-year students were scheduled in the SIM labs, but social distancing meant fewer students at a time.
A NEW NORMAL
For the fall semester, all lectures are online, Dr. Segura said. Exams are offered in seven sites on campus, she said. “In the past, one lecture hall was used to house an exam. Now due to social distancing, the same lecture hall can hold 36 students.
Dr. Segura said although primarily virtual learning lacks the personal interaction that everyone enjoyed before, the safety of the students, faculty and staff is more important.
“I am so proud that everybody stepped up and out of their traditional roles to ensure dental education continued in a safe environment,” she said. “We were on the academic frontline. We had to maintain continuity for all students. And, we were able to successfully graduate all of our dental and dental hygiene students.”
On the patient care side of the dental school, the leadership team responded proactively to the effects of the COVID-19 pandemic.
Gary Guest, D.D.S., associate dean for patient care, said, “In the beginning, we all thought it was unlikely to come here. It was strictly in China. Then we heard the virus was in Vancouver, British Columbia, and then in Seattle, Washington. It was in the U.S.”
As the leader of the clinical enterprise, Dr. Guest participated in regional conference calls with leaders from UT Health San Antonio, University Health System, the Veterans Administration, and STRAC (Southwest Texas Regional Advisory Council). “What we are able to learn from these discussions helped us prepare. We wanted to be proactive—not reactive,” he said.
Once the pandemic was confirmed in Texas, “everything went really quickly. By March 1, we knew we needed to identify high-risk patients. We put up signage at the clinics and created a questionnaire script to ask patients about their risk.
“On March 22, Governor Greg Abbott issued Executive Order GA-09 allowing only emergency treatment. We had to quickly determine the procedures to be able to continue providing emergency care in our advanced training and specialty clinics,” he said.
Dr. Guest said while the dental practice has been using personal protective equipment (PPE) on a daily basis, COVID-19 is an airborne virus so they had to acquire additional PPE. With assistance from Michael A. Charlton, Ph.D., assistant vice president for risk management and safety at UT Health, and Byron Hepburn, M.D., director of the university’s Military Health Institute and the liaison to STRAC, the school was able to get the additional PPE, including N95 respirators, face shields and plastic full-coverage gowns.
However, the concern of having enough PPE—without depleting local supplies needed by hospitals for COVID patient care—was another challenge that resulted in an innovative solution. Using emergency guidelines released by the Centers for Disease Control and Prevention, Dr. Guest and his team worked with Dr. Charlton and Facilities Management to build their own Bio Cabinet to house vapor hydrogen peroxide which can be used to decontaminate and sterilize the face masks and respirators so they could be used again.
“We learned we could reprocess the PPE with vapor sterilization,” Dr. Guest said. “We created our own central sterilization unit and quality control steps so it could be done on the premises of the Center for Oral Health Care and Research.”
A NEW PROCESS
In addition, the entire scheduling and pre-procedure process had to change. “First, we have to prescreen patients on the phone to see if they have any COVID-19 symptoms,” he said. “When patients arrive, they will be screened again for symptoms and their temperature taken. Then they are screened again in the chair.” Patients now must do a pre-wash with 1.5 percent hydrogen peroxide, Povidone Iodine, Peridex or Listerine.
Patients who will be undergoing aerosol-generating procedures must be tested for COVID-19 within 72 hours of their appointment. The tests are conducted by nursing faculty and trained dental faculty and staff at a specially designed testing site at the COHCR.
On May 11, a new executive order from Gov. Abbott allowed the dental practice to resume non-emergency dental care. “By the time the state allowed us to fully reopen, we had all of our new procedures and protocols in place. The state issued all the rules we needed to work under, and we were already doing them plus more. Thanks to the UT Dentistry Clinical Enterprise Committee, which consists of all clinic directors, we were able to have different perspectives and then could craft and implement all the safety and procedural rules.”
Dr. Guest said he is proud of the entire clinical team and appreciative of the support received from the UT Health safety experts. “We believe we have created as safe an environment as we can because we all worked together. Our faculty, staff and students all pitched in and helped out. They have been understanding, adaptive and compliant to all the new procedures. Our excellent people are the true testament of the quality of our dental school.”
Dean Peter M. Loomer, B.Sc., D.D.S., Ph.D., MRCD(C), FACD, said he is very appreciative of the creativity of the faculty and the staff. “Our team understands the importance of our missions and has worked hard to make sure we continue to fulfill these missions.
“The faculty and staff have been adaptable and have made the changes necessary so that we can continue to serve our patients, educate our dental and dental hygiene students, and perform our research activities,” he said.
Dr. Loomer said he has been impressed by the level of selflessness exhibited by the faculty and staff. “No one was thinking about themselves. They wanted to contribute to make sure we are offering the best patient care and, within our limitations, our best educational services. I am very proud to be a part of this team.”
Dr. Loomer said the pandemic also showed him the coordination of efforts found on the UT Health campus. “University leadership was outstanding in keeping us up to date on COVID-related issues. Our close relationships with the School of Nursing and the Long School of Medicine were mutually beneficial.”