Increasing the forensic relevance of oral health records – development and evaluation of online education for the dental professional

Abstract

Background: Dental comparison can confirm human identity to a high degree of certainty and has always played a major role in Disaster Victim Identification. However, a significant issue for human identification by dental comparison is a lack of adequate antemortem information. Previous research examining Australian-made clinical case notes demonstrated suboptimal recording of dental traits that are important for both forensic dental identification and compliance with Dental Board of Australia record keeping guidelines. In view of this, I have developed and evaluated an online programme of education to improve the clinical and forensic recording practices of oral health providers. Methods: To determine the practical influence of inadequate oral health case note recording on forensic identification, the outcomes of identification case investigations undertaken by the Forensic Odontology Unit of South Australia (FOU SA) over a five year period (2011-2015) were assessed. Subsequently, an online Interactive Learning Module (ILM) was constructed using Articulate Storyline 2 software (Articulate Global Inc.), with the aim to improve skills related to accuracy, detail, legibility, accessibility and retention of dental records. The ILM was initially made available to two focus groups – Australian Society of Forensic Odontology (AuSFO) Inc. members and third year students from the University of Adelaide’s Bachelor of Dental Surgery (2016) program. The ILM was subsequently released to the wider dental community via various professional groups. For all release phases of the study, Likert-style feedback was obtained before and after participation, with percentage, mean, broad agreement and standard deviation being determined for each survey statement. The statistical significance of differences between paired pre- and post-course survey responses were also determined, where relevant. Participants’ country of education, current occupation and level of experience were considered in analysing results. Results: The preliminary investigation into forensic identification cases carried out over a five year period revealed that in 25% of these cases, identity was not able to be established. Furthermore, in 100% of the non-established cases, deficiencies in antemortem dental data contributed to the inability of forensic odontologists to be specific with the identification outcome. This result highlighted the need for further education with regards to clinical record keeping. Surveyed participants from all three study phases reported satisfaction regarding the subsequently-released ILM related to improving antemortem dental case note recording, as considered by Kirkpatrick’s Levels of Training Criteria. Additionally, improvements in the recognition of the importance, knowledge, confidence, skill and motivation to learn regarding the subject matter were seen following participant interaction. Results were particularly noteworthy for participants whose highest degree of education was from Australia, as well as those with only 3-5 years of experience in their current occupation. Individual outlying opinions were recognised and discussed. Conclusion: Lack of antemortem data was shown to limit the ability of forensic odontologists to provide an optimal dental identification. The ILM that was subsequently released to improve education in this area proved valuable in increasing the self-reported awareness, understanding and attitude of participants that had identifiably different levels of previous case note recording experience. By prompting learning, this ILM has the potential to improve record keeping practices and hence aid in forensic dental identification. The information gathered in the process of creating this ILM can also aid forensic odontologists to determine how confident they should be about the accuracy of antemortem records as forensic evidence.