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'Walk in the shoes of some of the patients'

Poverty simulation hits some UNC dental students 'in the heart'

August 01, 2017

By Michelle Manchir

Chapel Hill, N.C. — Some third year dental students at the University of North Carolina at Chapel Hill earlier this year faced evictions, unemployment and keeping their families fed with an unstable income.

The hardships were part of a poverty simulation required by the university's school of dentistry as a prerequisite to the students' eight-week summer rotations serving patients primarily in communities throughout North Carolina.


Dr. Lampiris
The rotation is part of the school's Dentistry in Service in Communities program, which often places students in underserved communities. The program offers a cascade of benefits, such as providing increased access to care for patients who need it and clinical experience for students. It also serves as a way to help students become accustomed to working with patients from all backgrounds, said Dr. Lewis Lampiris, director of the Dentistry in Service to Communities program and former director of the ADA's Council on Access, Prevention and Interprofessional Relations (now called the Council on Advocacy for Access and Prevention).

"This experience helps the students become more empathetic, compassionate, less judgmental and it helps them walk in the shoes of some of the patients they'll be treating during their rotations," said Dr. Lampiris.

The students are broken up into families and given circumstances such as a fixed income or low-income jobs, children, bills and other responsibilities to manage in four 15-minute-long "weeks." The exercise demands strategical decision-making — do you stay home to care for a sick child and miss a day of work, possibly losing your job? Does missing work mean you can't pay the light bill? Can and should you pawn something to pay the landlord on time?

For third year dental student Kelsey Knight Cody, who played the role of a daughter not old enough to work nor stay home alone, the simulation "made me more empathetic toward my patients and their situations," she said.

"One of my classmates was the mother for another group and her child had an infected tooth," Ms. Cody recalled. "In the race to get everything done and everyone fed, the mother didn't have the time or resources to bring her child to the dentist. It made me wonder how many patients and families that I see are going through similar battles. Maybe they're doing the best they can and I need to see what barriers I can remove to improve their access. "

Dr. Lampiris said he emphasizes with the students that the simulation is "not a game," and that it "can never replicate real people's experience with poverty."

The responses from the students when they debrief about the exercise indicate that it's a meaningful experience for many of them, he said. Dr. Lampiris said students have called the experience "traumatizing, eye-opening and stressful." Seventy percent of student participants said in an evaluation following the event that it was "extremely valuable" for them.

"It hit them in the heart, which is what I wanted to see happen," he said.

Dr. Lampiris said the experience is potentially valuable for anyone working in health care, especially as the need for preventive and regular access to dental care among some populations widens. Ms. Cody said she agrees.

"I know the simulation can't exactly model the lives of those living in poverty, but I think this experience helped me more than learning about poverty through textbooks and statistics and it really should be incorporated at other schools," she said.

Since the first poverty simulation in 2013, the program has become a required perquisite for students doing summer rotations, Dr. Lampiris said.

For more information about the simulation, visit www.communityaction.org/povertysimulations.