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Continued Vigilance: Enhancing Diversity in Dental Education

The American Dental Education Association (ADEA) through its policies and programs has addressed the issue of underrepresented minorities in the dental profession, in dental education, and in access to dental care. ADEA’s long-held position is that, without minority practitioners, access to care will be limited or absent in minority communities throughout the nation.¹ The dental practice data from both the American Dental Association (ADA) and ADEA support this position. In fact, the ADA Survey Report 2000² documented the practice characteristics of U.S. dentists: black patients are the only racial/ethnic group that are seen primarily by black dentists.

ADEA also uses major national reports that provide data and recommendations for change that influence workforce policy across the health professions. Such documents include but are not limited to "Oral Health in America: A Report of the Surgeon General"³ and "Unequal Treatment: A Report of the Institute of Medicine, National Academy of Sciences."⁴

	ADEA Diversity Policy Statements

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ADEA’s major policy statements that guide academic policy and association action regarding access and diversity are included in the ADEA Bylaws and Policy Statements:

Bylaws Chapter I (Core Values), Section A, Number 5
Expanding the Diversity of Dental Education. The Association values diversity and believes that those who populate dental education—students, faculty, staff, administrators, and patients—should reflect the diversity of our society.

Policy Statement I. Education, A. Admissions, 1. Diverse System of Higher Education
All dental education institutions and programs should support and help enhance the diverse system of higher education. Continued autonomy and growth in the private and public sectors depend on the preservation of this diversity. The nation’s private and public systems of higher education are complementary and interdependent. Their preservation depends on the continued attention of all institutional members and ADEA itself. Students must have the freedom to choose, from the broad spectrum of dental education institutions and programs, the institution or program best designed to meet the students’ specific needs.

Policy Statement I. Education, A. Admissions, 2. Number and Types of Practitioners Educated
All dental education institutions and programs should use the public’s need and demand for dental services as the criteria for determining the number and types of practitioners educated; and constantly assess those needs and demands, and the ability of existing practitioners to meet them.

Policy Statement I. Education, A. Admissions, 5. Recruitment, Retention, and Access: Best Practices
The American Dental Education Association strongly endorses the continuous use of recruitment, admission, and retention practices that achieve excellence through diversity in American dental education. Dental education institutions and programs should identify, recruit, and retain underrepresented minority students and identify, recruit, and retain women students where inequities exist. Dental education institutions and programs should accept students from diverse backgrounds who, on the basis of past and predicted performance, appear qualified to become competent dental professionals. Such efforts to achieve a diverse student body are predicated upon a highly qualified applicant pool and the support of private and public funding that benefits qualified disadvantaged individuals regardless of race, religion, ethnic background, gender, or sexual orientation. Dental education institutions should seek to identify and implement best practices in the recruitment and retention of underrepresented groups, including but not limited to:

1. Commitment and proactive leadership to diversity initiatives from deans and program directors;
   
2. Identification and implementation of admissions committee practices that promote diversity;
   
3. Identification and use of noncognitive factors in admissions decisions;
   
4. Regional collaboration among dental education programs to increase the numbers and qualifications of underrepresented individuals applying to dental education programs; and
   
5. Collaboration with other organizations focused on increasing the numbers of underrepresented minorities in the health professions.
   

	ADEA Strategies to Enhance Diversity, 2005–06

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ADEA’s ongoing activities that are being conducted to promote diversity among applicants, students, and professionals include the following:

1. National Minority Recruitment and Retention Conferences. ADEA has held six successful national conferences that have developed a national focus network and forum for diversity issues. The conferences will continue to be held biennially to strengthen the national network of minority recruitment officers, allow for exchanges related to "best practices," and seek newer resources and ways of addressing the recruitment of underrepresented minorities to careers in dentistry. The Recruitment and Retention Conferences are cosponsored by the Procter & Gamble Company. The seventh conference is scheduled for Baltimore in December 2006.
   
2. Implement a Minority Faculty Development Program. The Minority Affairs Advisory Committee (MAAC) recommended that ADEA consider the implementation of a minority faculty development program. Medicine has a model program that is sustained with foundation funding. This recommendation was made in response to the ADEA Future Faculty Report. ADEA has received $2.4 million from the W.K. Kellogg Foundation to implement the ADEA/W.K. Kellogg Comprehensive Minority Dental Faculty Development (MDFD) Program. This grant award covers a six-year time period (2004–09).
   
3. Support Minority and Low-Income Dental Student Recruitment. The ADEA/W.K. Kellogg Foundation Access to Dental Careers (ADC) grant funding ($1.1 million) supports the recruitment component of the RWJF Pipeline grants. The California Endowment has provided $500,000 for five of the fifteen schools that are now included in the Pipeline Project. The National Advisory Committee meeting for the Pipeline Project was held in Washington, D.C., October 5–7, 2005.
   
4. Continue Legislative Agenda. The ADEA Legislative Agenda is crucial to minority student recruitment and retention. Resources provided to U.S. dental schools have been made possible through sustained legislative efforts directed toward federal funding available to dental schools, students, and faculty. ADEA will continue to provide advocacy for federal programs that support minority-focused programs, student financial assistance, student training, the Minority Faculty Loan Repayment program, and other opportunities that arise in the future.
   
5. Collaborative efforts with the American Dental Association with regard to underrepresented minority (URM) recruitment. ADEA is supporting the URM recruitment efforts of the ADA through its Ad Hoc Committee on Diversity to Attract Qualified Underrepresented Minorities into Dentistry. This sharing of information and effort will benefit all who are involved in minority student recruitment to careers in dentistry. Also, an ADEA staff member serves on the work group that is developing an expansive new website related to careers in dentistry (futuredentist.org).
   
6. Expand collaborative efforts with other associations. ADEA will continue to expand collaborative efforts with other organizations for mutual benefits to be derived from such associations. As the nation is challenged to address the disparities noted in the 2000 report of the U.S. surgeon general, such collaborations will be an imperative. ADEA will continue collaborations especially with the following: National Association of the Advisors of the Health Professions (NAAHP), National Association of Medical Minority Educators (NAMME), National Dental Association (NDA), Hispanic Dental Association (HDA), Friends of the Indian Health Service (FIHS), Society of American Indian Dentists (SAID), Association of American Medical Colleges (AAMC), Ventures Scholars Program (VSP), and the American Dental Association (ADA).
   
7. Expand Regional Workshops for Predental Advisors. ADEA has held seven regional predental advisor workshops in tandem with the association’s Annual Sessions since 1998. These workshops have targeted members of the National Association of Advisors of the Health Professions, regional recruitment, admissions, and financial aid officers, and other local individuals involved in dental student recruitment. The regional approach to advisor contact will continue to provide advisors with updated information and resources that will enhance their ability to influence the career choices of college students. Plans to expand these workshops are in progress for the conference that will be held in Orlando, Florida, in March 2006 and in Baltimore in December 2006.
   
8. Implement ADEA Resolution Regarding Cultural and Linguistic Competence (Resolution 12H-2000). "All dental education institutions should include cultural and linguistic concepts as an integral component of their curricula to facilitate the provision of oral health services." This resolution, developed by the joint activity of the ADEA Women’s Affairs Advisory Committee (WAAC) and Minority Affairs Advisory Committee (MAAC), was approved by the 2000 ADEA House of Delegates. The joint WAAC/MAAC committees will continue to advise the ADEA Board of Directors on ways to help dental and allied dental education programs address this resolution. As the cultural competency elements of dental and allied curricula evolve, the accompanying cultural changes within the academic environment are expected to enhance patient care and treatment outcomes in the future. The ADEA W.K. Kellogg Access to Dental Careers (ADC) grant in partnership with the RWJF Pipeline Project will contribute to curriculum development in the area of cultural competency in the fifteen dental schools receiving the ADC/Pipeline grants.
   
9. Support Minority Affairs Section Programming. The Minority Administrators and Faculty Special Interest Group became the Section on Minority Affairs in 1994. The goals of this section are to promote the recruitment and development of minorities as faculty and administrators in dental education and to heighten the awareness of other faculty and administrators regarding issues and concerns that have a significant impact on minorities in the academic environment. The Center for Equity and Diversity will support this section in its efforts to: recruit minority faculty, students, and administrators; ensure that the legislative agenda addresses the special needs of minorities in dental education; and facilitate collaboration with other sections for programs and activities that focus on diversity or cultural competency. For example, the center supported the section’s collaboration with the NDA in the Minority Faculty Forum planning at the Annual Convention of the NDA, Las Vegas, July 29-August 3, 2005.
   
10. Leadership Training for Minority Affairs Officers. The Gies Foundation has awarded grant funds to ADEA to provide leadership training for minority/diversity affairs officers in U.S. dental schools. The program will increase effective leadership in the areas of minority recruitment and retention, resource allocation, cultural competency, and outreach efforts.
    
11. Participate in the Health Professionals for Diversity (HPD) Coalition activities. The HPD Coalition is comprised of more than fifty health organizations across the health professions disciplines. The coalition has been reactivated by the Association of American Medical Colleges (AAMC) in response to the U.S. Supreme Court rulings regarding the University of Michigan affirmative action decisions. The coalition will address opportunities and challenges to promoting diversity in the post-University of Michigan decisions environment and in building support for diversity across the health professions.
    
12. Support the Report of the ADEA President’s Commission,"Improving the Oral Health Status of All Americans: Roles and Responsibilities of Academic Dental Institutions." The Center for Equity and Diversity’s programmatic strategies will continue to address the items included in Recommendation 4: "To increase the diversity of the oral health workforce."
    
13. Opportunities for Minority Students in U.S. Dental Schools (OMSUSDS). ADEA publishes this handbook, the only biennial publication designed to attract minority students to careers in dentistry. This unique resource guide contains information of interest to minority students for all fifty-six dental schools, including predental academic enrichment programs, minority student associations, the distribution of minority students by school, financial aid, a listing of additional information sources, and profiles of minority dentists. The fifth edition is scheduled for release in winter 2006.
    
14. College Board Enrollment Management Project. ADEA is a sponsoring organization of the College Board’s new initiative, "Enrollment Management and the Law: A College Board Collaborative on Access and Diversity Policies and Practices in Higher Education." The collaborative represents medical, dental, law, and graduate schools throughout the United States. Through a series of meetings and other discussions with practitioners, the collaborative will develop pragmatic strategic planning, legal, and policy tools to help institutions meet their diversity-related goals in ways that are legally sound. The two-year project will focus on financial aid and scholarships; outreach, recruitment, and retention; and admissions (specifically selection). In April 2005, the collaborative produced its first publication: "Federal Law and Financial Aid: A Framework For Evaluating Diversity-Related Programs" (available from the College Board at $15 each; to order by telephone using credit card, call 800-323-7155; for mail orders, write to College Board Publications; Dept. ADCO 405A, P.O. Box 869010, Plano, TX 75074). Four National Seminars on Race-Conscious Admissions Practices and the Federal Law are also scheduled: November 1–2, 2006, New York; November 16–17, 2006, Chicago; December 14–15, 2006, Atlanta; and January 9–10, 2007, Dana Point, California.
    
15. Ventures Scholars Program. ADEA is a member of the Ventures Scholars Program (VSP), a national membership program designed to promote equity in and access to higher education. The program identifies high-achieving, historically underrepresented, first-generation college-going students interested in pursuing math- and science-based careers and provides academic recognition, information, and resources to help them successfully reach their career goals. High school students are identified for membership in the VSP program based on their math and science scores on a standardized test administered nationally by the College Board. As a VSP member, ADEA has access to demographic data and career interests of the VSP student members. In a recent query of student members’ career interests, ADEA discovered that out of 400 respondents only two indicated dentistry as a career interest. The ADEA Center for Equity and Diversity works with the Council of Students Administrative Board to communicate with Ventures Scholars about the opportunities and benefits of a career in the dental profession.
    
16. Summer Medical and Dental Education Program (SMDEP). The Association of American Medical Colleges (AAMC) and ADEA have recently been awarded a $18.4 million grant from The Robert Wood Johnson Foundation (RWJF) to administer the SMDEP program. This program will award up to twelve grants to U.S. medical and dental schools for collaborative efforts to increase their underrepresented minority enrollment. These grants are expected to include recruitment and formally conducted six-week academic enrichment programs for undergraduate college students. The grants were awarded in fall 2005 for implementation in the summer of 2006. Each site will include eighty students per summer and will receive $300,000/year for four years. Dr. Dave Brunson is the ADEA program coordinator for this grant.
    
17. Collaboration with Association of Academic Health Centers (AHC). ADEA is collaborating with the Association of Academic Health Centers (AHC) on its new workforce pipeline project: www.ExploreHealthCareers.org. This project, supported by the Josiah Macy, Jr. Foundation has allowed the creation of a free website designed to attract more students into the health professions. The website is a national, central online source of information about the nature of various health careers, educational requirements, financial aid options, enrichment programs, and specialized training opportunities. At the present time, it contains information about more than sixty health careers (including dentistry), three rich databases, and data on broader health policy and health care issues.
    
18. Participation in Minority Career Fairs. ADEA staff participate in career fairs for high school and college students, as well as health professions advisors, promoting dentistry as a career.
    
19. Coordinating Efforts of Dental School Admissions, Financial Aid, and Student Affairs Officers (AFASA) Related to Diversity Initiatives. AFASA members have established work groups to explore possible collaborative relationships between dental schools in the recruitment, admission, and retention of minority and disadvantaged students and to further explore the use of noncognitive factors in admissions.
    

	Other Solutions

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Other solutions that promote diversity in the health professions have been suggested in a recent national report, "Missing Persons: Minorities in the Health Professions." This report of the Sullivan Commission,⁵ released in 2004, addresses diversity across the professions of medicine, dentistry, and nursing. The report, among its many recommendations, supports changes in admissions practices, funding resources, curriculum modifications that value diversity in the training of health professionals, and a broader recruitment strategy to health careers that includes community colleges.

	Summary and Conclusions

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The numbers of underrepresented minorities remain woefully disproportionate to their representation in the U.S. population. Minority populations in the U.S. are growing at a faster rate than the white majority. The practice characteristics of minority practitioners document their service to minority patients and in minority communities. These facts not only mandate that enrollments among these populations increase but also that there are adequate faculty role models and culturally sensitive academic environments that are critical to the professional development of all dental students.

The commitment of leadership at every level, from federal and state government and philanthropic organizations to our community partners and dental institutions, is critical if we are to improve access to health careers and ensure a diverse health care workforce for the future.

Dental education, with the support of W.K. Kellogg, RWJF, and the California Endowment, is now able to contribute to the diversity infrastructure of dental schools toward practices that expand the applicant pool, modify curriculum with regard to cultural competency, and evaluate outcomes and "best practices." The models that are now in place create a challenge to the profession and to the nation.

	Footnotes

 
Dr. Sinkford is Associate Executive Director and Director, Center for Equity and Diversity; Dr. Valachovic is Executive Director; and Ms. Harrison is Director of Program Services, Center for Equity and Diversity—all at the American Dental Education Association. Direct correspondence to Ms. Sonja Harrison, American Dental Education Association, 1400 K Street, NW, Suite 1100, Washington, DC 20009; 202-289-7201 phone; 202-289-7204 fax; HarrisonS{at}ADEA.org.

	REFERENCES

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1. Haden NK, Catalanotto F, Alexander C, Bailit H, Battrell A, Broussard J, et al. Improving the oral health status of all Americans: roles and responsibilities of academic dental institutions. J Dent Educ 2003;67:563–81.[Abstract]
2. American Dental Association Survey Center. Dentists and patients by race ethnicity. Chicago: American Dental Association, 2000.
3. Oral health in America: a report of the Surgeon General. Department of Health and Human Services. Rockville, MD: USPHS, 2000.
4. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: Institute of Medicine, National Academies of Science, 2002.
5. Missing persons: minorities in the health professions. A Report of the Sullivan Commission on Diversity in the Healthcare Workforce. W.K. Kellogg Foundation, 2004.

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