Get to Know Dr. Hugh Silk, and How He’s Advancing Integration Through His Work with CIPCOH

Hugh Silk, MD, MPH, is currently a professor in the department of Family Medicine and Community Health at UMass Medical School, a position that he’s held since 2006. Silk is also a part-time lecturer at the Harvard School of Dental Medicine since 2015. He is a co-principal investigator for the Center for Integration of Oral Health and Medicine (CIPCOH). Silk also serves as the medical director at a primary care wellness center in western Massachusetts.

Hugh Silk, MD, MPHWhile Silk’s career has skewed toward the integration of oral health and primary care, this was not always the plan. After graduating from Harvard College in 1991, Silk went on to study medicine at McMaster University in Canada. He began his residency at UMass Memorial Medical Center Family Medicine in 1998, and it was there that he first began to notice the links between oral health and medicine. At the time, he observed many of his young patients suffering from poor oral health, most likely due to a lack of fluoridation in the local water supply. He and his mentors were unsure of how to address this growing issue. Silk practiced family medicine for several years before returning to UMass to work in their residency program providing full-spectrum care, or comprehensive care through all stages of life. Much of his current work focuses on mentoring students, advocating for integrated care, and leading groundbreaking research with CIPCOH.

The Center for Integration of Primary Care and Oral Health was established in July of 2016 through a cooperative agreement with the Health Resources and Services Administration (HRSA) of the United States Department of Health and Human Services (DHHS). CIPCOH serves as a national resource to consolidate the evidence base for systems-level oral health integration into primary care training. CIPCOH envisions the role of integrative training and practice leading to cost-effective, patient-centered, and improved patient outcomes within the delivery of primary care. Harvard School of Dental Medicine associate professor of Oral Health Policy and Epidemiology Christine Riedy, PhD, MPH, is the lead principal investigator for CIPCOH, with Silk and Russ Phillips, MD, as co-principal investigators. CIPCOH is a major effort for Harvard School of Dental Medicine in transforming health professionals training to integrate oral health competencies into primary care programs at both didactic and and clinical training sites.

In year one, we surveyed 13 disciplines that represent primary care – hundreds of schools and programs from midwifery to family medicine, osteopathic schools to nurse practitioners – and got a snap-shot of oral health training in non-dental health education,” said Silk. “Meanwhile, we were doing systematic reviews of core competencies and evidence around training in the literature.”

The next step in CIPCOH’s research focused on programs and schools that had robust oral health curricula. Silk and his colleagues interviewed over 30 programs and schools, which resulted in a qualitative report reflecting what is necessary to succeed in integrating oral health education in a medical setting. “We have learned a lot about the roles of advocates, proper funding, and using existing resources,” Silk concluded. “We are now creating a tool that is based on all of that work which will allow programs across the country to complete an online evaluation and receive feedback on how to improve. This will allow all health-related schools and programs to get a sense of where they stand and how they can get to a better place in their teaching using existing resources.”

Silk believes that the integration of oral health and medicine, and the work of organizations like CIPCOH, is not only important, but essential. “We know that the mouth affects the body and vice versa in profound ways,” he said. “Numerous studies have shown that poor oral health affects a child’s ability to concentrate in school and their feeling of worth. Children with poor oral health are four times more likely to have a lower GPA. Adults fail to get jobs, end up hospitalized, and waste health and tax dollars in hospitals, emergency rooms, and outpatient visits.

 

Silk and his colleagues at CIPCOH have presented their findings at more than 20 healthcare and medical education meetings in four countries, and have had 10 different papers published in a variety of publications. “We are shedding light on what has been accomplished thus far in oral health education in primary care training in the U.S. and also what still needs to be done. I think our work has been and will continue to be very influential,” said Silk.

 

In Silk’s eyes, the future of oral health and primary care integration is bright. “I like to think boldly,” he said. “I think the last 20 years were setting a framework and a cultural shift within healthcare to make more creative and brazen changes in medical-dental integration on the education and practice front. In the next 10 years, I think we will see much more interprofessional education of dental learners and medical learners working on cases together and seeing patients together.

“From a public health perspective, we will see oral health being addressed more and more in places where people frequent, such as community health centers, schools, the workplace, and even in their own home. This is an exciting time to be a part of this essential movement!”