Appendix B:

SAMPLE QUOTATIONS FROM THE FOCUS GROUP

Theme	Representative verbatim focus group comments
Understanding of roles and responsibilities	FG2: I did get a chance to kind of help out, assist, and I felt like it gave me a better understanding of what they actually do. FG3: …Because you don't really know what they're doing over there. Like you know they pull teeth, they do fillings, all that stuff, and I'm like, I don't know what it looks like or what materials you need… FG2: …I liked the learning experience of it…Just seeing what stuff they use. I really liked getting more dental knowledge…like a higher dental IQ basically, just knowing what are some things that they look for. They kind of gave good tips too when we were working together. Like, “Oh look at that,” “isn't that interesting,” and would point things out that your eye may not be able to catch. So that was interesting to me…it's stuff that you don't learn in school. FG1: One thing that kind of made me have that light bulb moment was [providing dental hygiene therapy to a DDS student during a cancellation]. So, I brought him over and I'm just working away, and he was like “wow, you guys really hold the tool proper…you really have a lot of control! I don't do that” …and…it was just kind of a moment like, so we are very much an expert on what we're doing, while you're very much an expert on what you're doing…They're just totally different kind of professions. FG5: You can't do one without the other.
Hierarchical perceptions and level of experience	FG5: The dentist that we went up north with, I don't think he actually knew that we can diagnose… FG4: Yeah, he didn't. They don't know our scope of practice… FG5: …He looked at my diagnosis and he crossed it out. He's like, “You didn't diagnose anything these whole two weeks,” and I was kind of like, “Excuse me? Like, everyone had perio, I diagnosed a lot.” He just put a line through it. I was like, this makes me feel worthless, almost, you know? FG3: …I think [with] experiences like the northern rotations…you get more of a respect. I think the dental students that will graduate, who have gone through and seen what a hygienist can do…they will be further prepared [to collaborate]. FG3: You don't know if [the DDS will] give you the amount of respect that you think you deserve as a hygienist, like that power kind of thing. FG2: ...I'm kind of nervous for entering private practice…one thing that's different from going up north is that they will be your boss...who should be held above you kind of, you know what I mean? That's kind of how it works… FG5: To build on that, obviously if a dentist hires you, they're your boss and there's a hierarchy in that way. But I guess I would hope that in terms of clinical care and patient-centred care that they would view me as an equal. FG6: ...I went to school. I know what's acceptable so I feel like I should be able to make that call. I don't want to be dictated on what I do for my patient's care.
Hierarchical perceptions and level of experience	Facilitator: For my understanding…you found that there was less collaboration when [the DDS student] had more experience? FG4: Yeah, you're not on the same level. FG3: It wasn't like asking questions about things together, like working through situations being like “oh I've never seen this before.” It's more like they're doing their thing, we're doing our thing, and it's kind of black and white. FG4: Whereas when the dental students are in the same year of learning as us, they don't know as much as we do so they're not, it was…more of a mutual respect, I think. FG1: It was like both students learning together. Facilitator: …So, on the flip side, if you were to have more experience…How do you think that exchange would go? FG1: …more confidence, less intimidation, maybe. FG4: I feel like…once you feel comfortable with hygiene, it's much easier to just be like, “Hey this is what I found” or ask, “Hey, is this a carious lesion?”… FG2: I do think it's super important to know your role so you can be confident in it…I find that I got more confident asking questions because I know now what I should and shouldn't know…that gave me more confidence and especially getting to know the mutual respect thing too, that you can just ask and not be judged. FG3: …[Also], if you ever get questioned you know where you stand. FG5: Yeah, like when that dentist said, “You guys don't diagnose” …I should have been like, “Are you kidding me?”
Team dynamics	FG1: Dental students kind of seem intimidating at first…but then once you actually get to know them, you are in the same kind of boat. FG3: …I was a little bit, not scared of [the DDS students], but just kind of timid to approach them at the beginning. Whereas, by the end of the two-weeks you've been living together, you really build a good relationship and I would be totally comfortable just walking up, whether they have a patient or not and be like, hey, when you get the time, come and do a recall exam for me. So…I think you build that trust over time. FG6: The more time you spend with them, the more comfortable you'd be. If we only had a couple days rotation with the dental students (FG2: so true), well, we wouldn't be opening up (FG1: absolutely not). But the two weeks, over that time we open up. FG1: And you're with each other 24/7, too. FG5: I find that, once that trust is kind of built we both were asking each other questions about each profession… FG2: …It's almost something your ego doesn't want you to ask, right? When you're not comfortable around someone. You just want to be like, ok, I'm going to pretend I know what that is because I'm not dumb. [laughter] FG3: But once they ask us stupid questions about hygiene, then I'll be able to ask you a stupid question about dentistry. FG1: Yeah, like breaking that barrier.
Instructor and staff involvement and support	FG5: I think [the satellite instructor and staff] really help…or hinder the collaboration between the students. FG2: True. They're kind of the framework, right? FG5: Because if they're saying, “Okay, this person has charting, let's help them with this”, it kind of shows this is the expectation in the team dynamic and it just sets the tone. FG3: …I found it was different the two different times. The first time I went, the supervising dentist was like, “Oh, I know that the dental students are done right now so I'm going to get them to come check, and then I'll come double check later” …but then the second time I went, I was in a secluded room and I never saw any of the other students, so it was just me and the dentist. FG2: …honestly, we didn't really collaborate a lot because we didn't even know that was a thing really because the supervising dentist was kind of sitting back. FG4: The assistants in [location 1] worked together so much better…[RDA1] would be like, “this is our amazing, beautiful, receptionist”…whatever [RDA1] actually thought of her, she showed us that you respect her…Whereas in [location 2] I found the team was more like…“Hey, you would never guess what [this staff member] did to me” and “this dental student's really pissing me off.” [agreement]. FG3: …In [location 1] they'd be like, “[FG3], I see you have two or three charts that you need to catch up on, let me wipe [your operatory]” to help out, collaborate…to get out of there together. Whereas [in location 2] I felt very isolated... FG2: I actually sometimes found that I wish that there's a hygiene instructor up north. FG5: to advocate for you? FG2: …Yeah, when you're booking someone back because they have severe perio, you're not getting questioned on why or something. [agreement]. FG4: …That communication was a little rough of what we needed because it was very focused on dental, so it was like hygiene, well you should know what you should be doing. Like the dentists going up are focused more on the dental aspect of it… FG3: I think because it's a dental supervisor, they were more like (FG2: on the same page [with the DDS students]), talking about very specific things [to the DDS students], like hey you need to work on this specifically, whereas when they came over to us, they [wouldn't provide] as direct guidance that we're used to in our clinic [by our DH instructors].
Timing and structure of IPE activities	FG5: I think it helps with the collaboration in the satellite versus [the university clinic]. In [the university clinic] we're all doing our own thing. You don't know what the dentists are doing. They don't know what you're doing. Whereas, when you're on satellite, you see the schedule, you see, oh, this dental student has a root canal, and after you could ask them how did that root canal go, or you can say, “Oh, can I see that x-ray, will you tell me about this?”…You know, you have a better idea of what everyone's doing and you're working more closely, side by side, rather than just on separate sides of clinic. FG1: …You're being graded on [everything] so you want to make sure it's perfect and good. Versus up north, you're being graded on the full two weeks in general, so you are not as afraid to make a mistake… FG2: It's so much easier to collaborate up north. FG3: [It is] more like private practice because you're not getting graded on everything it's more self-assessment. FG6: I think…making [the university clinic] seem more like a private practice. So even on our first appointments with patients when we're doing all the assessments, just have the dental students come in for like ten minutes to do that quick peek for their recall exam, so they get used to having to leave their patient to go check our patient, and then were getting used to sharing our patient with the dentists. FG3: …I think if we had better access to [the] dental students in our normal clinics…even if it's like a wandering student dentist, like your dental lead, who can just pop in, be the recall [person] for the day. Facilitator: What would help improve collaboration and help you get to know the DDS students? FG6: ...I think…being able to collaborate with the dental students throughout our whole education, not just on selected things like our northern rotation or screening diagnosis, PEDO…almost make it more of a day-to-day type thing. FG5: …I know we take the same, almost, oral pathology course and like a lot of similar things. They should try and combine those… FG2: …I really remember [the team building] from the first week, but it was tough because there's all the different professions there. FG6: It's not just hygiene and dentistry…I think it would be really cool if we did that at some point throughout the program…a bit later on too? FG4: But then it's like, go with the [DDS] year that you're going to [work in clinic] with…end up with [clinically]… FG5: ...Doing clinical case studies, and you could talk about…this is what I bring to the table, this is what I can say about it, and then they can say, and this is what I know…cause then you're able to role define, talk about scope of practice, learn things from each other…