Assessment of the educational needs and services available in cleft /lip palate and craniofacial anomalies management in South Africa.

Abstract

ABSTRACT Background Since the 1960s, South Africa has been providing multidisciplinary treatment for children with cleft lip and/or palate (CLP) and craniofacial anomalies (CFA) (Marks, 1960). Currently, the standard for best practice (ACPA, 2017) regarding cleft lip/palate and craniofacial anomalies focuses on oral function, improved appearance, and normal speech. Therefore, American cleft palate association recognize the core of the cleft palate team comprises maxillofacial and oral surgeons (MFOS), orthodontists (Orthod), plastic surgeons (PS), and speech-language therapists (SLT). Cleft lip/palate and craniofacial anomalies vary in severity and facial growth patterns, and treatment is complex and lengthy. Therefore, it requires collaboration among different disciplines, with the aim of reaching the treatment goals of good facial growth, aesthetically acceptable appearance, and dental occlusion. Consequently, it becomes increasingly important to provide adequate training for these professionals, to empower them not only to provide efficient treatment, but also to assume leadership roles in this field. This is the first study ever to include all four disciplines. Objectives To obtain information regarding the CLP/CFA academic education of MFOS, Orthod, PS and SLT; the services that those practitioners offer to CLP/CFA patients; and the educational and training needs in this field. Methods A 51-item online survey questionnaire was used to collect quantitative data of a randomised sample of professionals from the four disciplines: MFOS, Orthod, PS and SLT. The study was introduced to the participants by means of a telephone call and they were given the option to record their responses or to send the online questionnaire by email. For the orthodontists, the data was collected during their annual scientific congress by two students using an iPad. Results The questionnaire was completed by 46,3% of MFOS, 41% of Orthod, 46,5% of PS and 18,83% of SLT who are registered on the Medpages database. Although 42,6% of the participating MFOS, 92% of Orthod, 41,6% of PS, and 42,7% of SLT indicated that they provide treatment and intervention for CLP/CFA patients, only a few felt confident to provide such services. The study shows that professionals are treating patients beyond their competence, which could result in poor outcomes and services. Most of the respondents agreed that there is a need to improve CLP/CFA education, and the majority recommended fellowship, sub-speciality training and/or certified courses. The minority suggested continuing-education workshops. Conclusion Most of the professionals who participated in this study provide treatment for both CLP and CFA patients, despite some of them lacking in confidence when treating such cases. The majority agreed that there is a strong need to establish an educational strategy to meet the needs of professionals who treat CLP/CFA patients. The respondents suggested dedicated programmes in the CLP/CFA field. The professionals recommended fellowship, sub-speciality training, certified courses, and continuing-education workshops.