ADA News

Drs. Bailit (left) and Formicola

All good things come to an end, but the principals behind the Dental Pipeline, Profession and Practice: Community-Based Dental Education program that began in 2001 and draws to a close next month say this is only the beginning of more focused efforts to change the way dental students are recruited, educated and trained.

The resulting initiatives put into place and tested by the 23 participating schools will leave a lasting impact on dental education, co-directors Dr. Howard Bailit and Dr. Allan Formicola told program directors from dental schools, deans and guests gathered May 5-6 for the Dental Pipeline Monograph Conference at ADA Headquarters.

"While the program is ending, we believe it has been a catalyst for dental education," said Dr. Formicola. "The monograph we are developing will provide information to help guide all dental schools who wish to develop successful community-based student programs and recruitment and enrollment programs for underrepresented minority students."

Directors: Pipeline program directors Dr. Douglass Jackson, University at Washington, and Dr. Ana Karina Mascarenhas, Boston University, hear strategies for student recruitment and enrollment programs May 5 at the Dental Pipeline Monograph Conference.

The conference provided contributing authors with an opportunity to present papers for the monograph, "Strategies for Operating Community-Based Dental Education and Underrepresented Minority Recruitment and Enrollment Programs," which will be published in the Journal of Dental Education this fall.

The Robert Wood Johnson Foundation set out to change dental education after publication of the 2000 U.S. surgeon general's report "Oral Health in America" highlighted growing oral health disparities, especially in vulnerable populations, including low-income individuals, medically disabled and geographically isolated individuals. There were several contributing factors named in the surgeon general's report, including:

• a limited national dental care safety net;
• a lack of dental workforce diversity;
• the rising cost of dental education, which contributes to the decline in students from lower income families.

In 2001, the RWJF launched a $19-million program that would develop new initiatives focusing on two areas: increasing minority and low-income student enrollment in dental schools and exposing all dental students to community-based practice in underserved areas.

In its first phase, the RWJF funded 11 dental schools with five-year grants of up to $1.5 million to address the problems cited in the surgeon general's report. The California Endowment contributed another $6.3 million, which allowed all California dental schools to participate. Over five academic years, the schools would:

• increase the time senior dental students and residents spent in community-based clinical education programs;
• revise dental school curricula to support community-based education programs;
• take action to increase recruitment and retention of underrepresented minority students.

UIC: Dr. Darryl Pendleton, UIC associate dean for student and diversity affairs, discusses school environment in promoting diversity.

The foundations launched a second phase in 2008, which provided 27-month grants of $200,000 to eight more schools to replicate best practices from the first 15 grant recipients.

"These programs are an essential component of dental education now," Dr. Bailit said at the conference. "This is an important way that the educational community can make contributions to access disparities."

Most importantly, the program’s ideals do not end with the foundations' financial support, said Dr. Formicola. "These schools sustain these programs on their own now by having made changes in their curriculum, recruitment of underrepresented minority students and admissions policies."

As the first phase of the Pipeline funding drew to a close in 2007, researchers began to publish results of the program. What emerged were promising results: schools could improve access through their educational programs; address the shortage of minorities entering the profession through recruitment efforts to appeal to students of color and students from disadvantaged backgrounds; and schools created service learning programs that enabled all students to gain a better understanding of the oral health problems of the underserved living in low-income urban and rural areas.

The following conclusions appeared in "The Dental Pipeline Program's Impact on Access Disparities and Student Diversity" (The Journal of the American Dental Association, 2009):

• All 15 participating schools increased the length of time that senior students spent in community-based dental rotations, from an average of 10 days at the beginning of the program (2002-03) to an average of 52 days (2006-07). Many have sought employment in community clinics after graduation, said Dr. Bailit.
• All schools made changes to their curricula to prepare students for community-based rotations, including adding courses or integrating new content into existing courses, especially on community dentistry, patient management and communication/cultural sensitivity.
• Applications from and enrollment of underrepresented minority (URM) students at participating dental schools increased between 2002-03 and 2006-07 (excluding Howard University and Meharry Medical College, two historically black dental schools).
• Applications of URM students increased by 77 percent—from 1,831 to 3,249. Enrollments of URM students increased 54.4 percent—from 90 to 139. As a proportion of the entering class, underrepresented minority students increased from 7.7 percent in 2002-03 to 11.7 percent in 2006-07.
• By contrast, enrollment of URM students in all the non-Pipeline schools (excluding Howard, Meharry and the University of Puerto Rico) increased only 16 percent.
• Almost all senior students participated in community rotations.

Input: Dr. Sarita Arteaga, Hispanic Dental Association past president, at the May Pipeline conference.

The Journal of Dental Education monograph will highlight ways that schools increased outreach to underrepresented minority students and other strategies. Examples include summer enrichment programs, postbaccalaureate programs for URM students, recruitment materials directed to URM college students and collaboration with college preprofessional health advisors.

The Pipeline program had its first meeting at ADA Headquarters in 2001. After the monograph conference last month, Dr. Formicola said it was gratifying to "book-end" the program at the ADA.

"This is the end of a wonderful journey," he said.

Dr. Bailit quoted Winston Churchill from 1942: "Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."