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An Assessment of Cross-Cultural Education in U.S. Dental Schools

Key words: culture, dental curriculum, dental school, race, ethnicity, survey

Submitted for publication 12/01/05; accepted 02/24/06

	Abstract

Top Abstract Methods Results Discussion Conclusions and Recommendations Appendix References

 
The purpose of this study was to assess the status of cross-cultural education in U.S. dental schools and to identify characteristics associated with having a formal cross-cultural curriculum. An eighteen-item survey, which included questions about curricular format, teaching and evaluation methods, time, and course content, was sent to all U.S. dental schools. Comparisons were made using whether or not institutions had formal cross-cultural curricula. Forty-five of fifty-six schools responded. Twenty-nine schools reported having formal cross-cultural curricula in a separate course and/or integrated with other courses with specific goals and objectives. Schools that have formal cross-cultural curricula had higher scores on depth of curricula and spent more time than schools that reported having informal curricula (p=0.03). Competing curricular time and lack of faculty expertise were the most frequently cited impeding factors for inclusion of cross-cultural issues (87.8 percent and 68.3 percent, respectively), while diverse patient population and leadership commitment were the most frequently cited facilitating factors (92.5 percent and 67.5 percent, respectively). There is wide variation among dental schools regarding how they teach these issues and how students are evaluated. Dental schools lack guidance about how to best incorporate this curricular content.

Cultural competence has been emphasized recently as an important component of the health care process. The ongoing process of cultural competency can be viewed as a set of academic and interpersonal skills that allows individuals to increase their understanding and appreciation of cultural differences and similarities.⁵ Many strategies for dealing with cultural issues emphasize the role of education because cultural competence is widely recognized as a learned process.⁶ Many professional and educational organizations have realized the importance of cultural competence, resulting in efforts in medicine, nursing, and other health-related fields to include cultural competence in their curricula and continuing education.^7–10

Studies have been conducted to evaluate the effect of different educational interventions on the attainment of cultural competence.^{6–8,11–13} A systematic review by Beech et al. synthesized the findings of studies evaluating interventions to improve the cultural competence of health professionals. Beech et al. found evidence that cultural competence training improves the knowledge of health professionals (seventeen of nineteen studies demonstrated a beneficial effect on provider knowledge) and found evidence that cultural competence training improves the attitudes and skills of health professionals (twenty-one of twenty-five demonstrated a beneficial attitudinal effect, one study showed no effect, and three studies showed a partial/mixed effect).¹⁴ Of the fourteen studies that evaluated skills only, all demonstrated a beneficial effect. Results of measuring the intermediate outcomes of knowledge, skills, and attitude of providers also have been encouraging.

Dental educators realize the importance of providing students with the skills and tools to assist them in becoming more culturally competent as evidenced by the accreditation standard established by the Commission on Dental Accreditation that states: "Graduates must be competent in managing a diverse patient population and have the interpersonal and communication skills to function successfully in a multicultural work environment."¹⁵ Dental schools are left to determine the methods by which to achieve this standard. The format and extent to which dental schools incorporate cross-cultural education in the curriculum is not documented in the literature. Thus, little is known about the curricular content, teaching methods, or outcomes evaluation for cultural competency.

Since 1992, there have been four North American surveys concerning the incorporation of cross-cultural issues in medical schools.^6,16–18 In addition, a literature search identified and described programs that teach cultural diversity issues to undergraduate medical students in the United Kingdom, United States, and Australia.¹⁹ Cross-cultural education in medical specialty training programs also has been described.^20,21 One research team concluded that the medical field needs to move from descriptive studies towards more rigorous evaluation of effects of cross-cultural education on clinician behavior and patient care outcomes.¹⁸ Dentistry, however, still needs descriptive information before it can proceed with further evaluation and research. There are limited data concerning cultural competency in the curriculum of U.S. dental schools.²²

Acknowledging the importance of including cross-cultural education for future dentists, and in the absence of formal, uniform consensus on how this should be done in health care professions, baseline information on how cross-cultural issues are addressed in dental schools is needed. The aims of our study were thus to assess the current status of cross-cultural education; identify whether there is a relationship between several general institutional characteristics (e.g., percentage of students, faculty, and patients who are from a minority racial group) and whether the school addressed cross-cultural issues; and explore the content, teaching methods, and evaluation methods for teaching cross-cultural issues at U.S. dental schools. While culture goes beyond race and ethnicity to include socioeconomic status, religion, gender, sexual orientation, occupation, disability, etc., our research focused on the race and ethnicity components of culture.

	Methods

Top Abstract Methods Results Discussion Conclusions and Recommendations Appendix References

 
This research was a descriptive, cross-sectional study of the status of cross-cultural education in U.S. predoctoral dental schools. The original eighteen-item survey instrument was divided into four major sections: 1) questions about racial/ethnic percentages of dental students, faculty, and patients visiting the dental school clinic; 2) how faculty members address cross-cultural issues at their schools (years in curriculum, methods of teaching and evaluation, clock hours devoted to cross-cultural issues, extent to which certain topics are addressed, and why the respondents thought cross-cultural issues were or were not addressed in their schools); 3) extramural or outreach programs; and 4) a free-response question for additional comments. (The survey appears as an appendix.) Some response options are based on the existing literature. Findings concerning extramural programs are not included in this article. Three University of Iowa faculty members and an ADEA staff member revised draft copies of the survey for its content and clarity. Although this survey was exempt because it does not collect personal or "human" information, a copy was filed with the University of Iowa Institutional Review Board office.

For this study "formal cross-cultural curriculum" is operationally defined as a dental school that reported addressing cross-cultural issues in a separate, independent course and/or integrated with other courses with specific goals, objectives, and methods of evaluation. Conversely, "absence of formal cross-cultural curricula" is defined as schools responding that cross-cultural issues are either not addressed at all or are integrated with other courses without specific goals and objectives.

Schools were categorized as either public or private, and each was placed into one of four regional geographic areas (Northeast, South, Central, and West).²³ Time devoted to cross-cultural issues was divided into six categories: <5, 5–10, 11–20, 21–30, 31–40, and >40 clock hours. Percentages of each racial/ethnic category collected by the U.S. Bureau of the Census were requested for students, patients, and faculty. A new variable was created that summed all of the minority racial/ethnic categories for each of the three groups.

Each school was asked to identify when (D1–D4) cross-cultural issues were addressed in its curriculum. Responses were also grouped into preclinical years (first two years) or clinical years (last two years). Teaching and evaluation methods were selected based on the most frequently cited methods in the literature, with "other" provided to allow schools the opportunity to explain any other method they use. Schools were asked to rank order the top three facilitating and impeding factors to why (or why not) cross-cultural issues were addressed.

The extent of the cross-cultural education within the school’s curriculum was measured on a 4-point scale (0=not addressed at all, 1=minimally addressed, 2=moderately addressed, 3=extensively addressed) for the following seven content areas: definitions and concepts of culture, diversity, ethnicity, and cultural competence; oral health cultural belief models and practices; access issues; oral health disparities; communication and interviewing skills; issues related to Limited English Proficiency (LEP); and awareness and respect of culturally different groups. The maximum possible total score was 21.

Content areas were further divided into knowledge (i.e., definitions and concepts of culture, diversity, ethnicity, and cultural competence; oral health cultural belief models and practices; access issues; and oral health disparities) and topics that focus on skills and attitude (i.e., communication and interviewing skills; issues related to LEP; and awareness and respect of culturally different groups). The maximum score for knowledge was 12, whereas the maximum for skills and attitude was 9.

In November 2004, one author (YC) sent an introductory email stating the purpose of the study and encouraging participation to the dean of academic affairs or equivalent at all U.S. dental schools. A hard copy of the cover letter, which reiterated the purpose of the study and encouraged the academic deans to share the survey with appropriate faculty and staff, was mailed along with the survey and a stamped return envelope. Fourteen schools responded to the initial mailing. A second mailing to non-respondents was sent after one month. Telephone calls were made to each school that didn’t respond, reminding them of the survey and encouraging their participation. Schools that could not be reached by telephone were contacted by email. By March 2005, thirty-one additional surveys were returned for an overall total of forty-five responses.

Data were entered into an Excel file and exported to SAS version 9.1 for data analysis. Wilcoxon rank sum test, a nonparametric test for data that are not normally distributed, was performed to find the relation between the dependent variable and minority percentages and clock hours. Chi-square statistic or Fisher’s exact test was used for comparisons with categorical data. Statistical significance was set at p<0.05.

One-way analysis of variance was used to compare the mean scores of the variables "total content," "focus on knowledge," and "focus on skills and attitude" by the format of cross-cultural course (i.e., a separate course, integrated with specific objectives, or integrated without specific objectives). Substantive and statistically significant variables were entered into a logistic regression model that compared those with and without a formal cross-cultural curriculum that included race/ethnicity.

	Results

Top Abstract Methods Results Discussion Conclusions and Recommendations Appendix References

 
Forty-five dental schools (80.4 percent) returned the survey. The percentage of minority students ranged from 4 to 100 percent, with a mean value of 36.1 percent (S.D. 22.4 percent) and a median of 33 percent. The percentage of minority faculty ranged from 4 to 100 percent, with a mean of 25.8 percent (S.D. 19 percent) and a median of 20 percent. The percentage of minority patients ranged from 30 to 100 percent, with a mean of 56.2 percent (S.D. 14.9 percent) and a median of 55 percent. However, ten schools indicated that statistical information concerning patients’ race or ethnicity was not collected, and thus they did not respond to these questions about student, faculty, and patient ethnicity.

Twenty-eight public and seventeen private schools returned the survey. The geographic distribution of the respondents was: Northeast, nine; South, sixteen; Central, ten; and West, ten. Four schools indicated that cross-cultural issues were not addressed at all. While ten schools addressed cross-cultural issues in a separate independent course, four schools reported that this was the only way they addressed cross-cultural issues. Twenty-five schools (55.6 percent of the respondents) indicated that cross-cultural issues were integrated within other courses with specific goals, objectives, and evaluation methods pertinent to the topic, while nineteen schools addressed cross-cultural issues integrated within other courses but without specific goals and objectives related to the topic. Twelve of these nineteen schools reported that this was the only way they addressed cross-cultural issues. These twelve schools, in addition to the four schools that responded they don’t address cross-cultural issues at all, were operationally defined as not having a formal cross-cultural curriculum. The remaining twenty-nine schools, which addressed cross-cultural issues in a separate course or integrated with other courses with specific goals and objectives, were defined as having a formal cross-cultural curriculum.

Of the forty-one schools that reported some type of formal or informal cultural competency instruction, thirty-four addressed cross-cultural issues in the D1 year. This number decreased with each subsequent year (D2, thirty-one schools; D3, twenty-eight schools; and D4, twenty-two schools). Only 39 percent of responding schools said that they addressed cross-cultural issues in all four years. While eleven schools reported that they addressed cross-cultural issues in preclinical years only, one school addressed cross-cultural issues only during clinical years. Twenty-nine schools (70.7 percent) addressed cross-cultural issues in at least one preclinical year and one clinical year.

Of the forty institutions that responded to the question regarding clock hours devoted to cross-cultural education, four had fewer than five hours, ten had five to ten hours, thirteen had eleven to twenty hours, three had twenty-one to thirty hours, six had thirty-one to forty hours, and four had more than forty hours. Most of the schools (80 percent) indicated that cross-cultural teaching had increased in the past five years at their schools, while 20 percent indicated that it had stayed the same. None of the schools responded that cross-cultural education had decreased.

The most frequently reported teaching method was lecture/seminar (n=39, 95.1 percent), and the most frequently reported method for student evaluation was through written exams (n=26, 63.4 percent) (Tables 1–2). While seven schools (17.1 percent) reported using lecture/seminar format as their only method for teaching cross-cultural education, thirty-two schools (78.1 percent) used multiple educational methods in addressing cross-cultural issues.

Of the thirty-eight institutions that responded to the question of how extensively they addressed each of the seven topic areas, three schools scored the maximum (21), which means that they reported addressing each of the seven areas extensively. Conversely, three schools scored less than 10. Most topics were reported to be moderately addressed. Among the knowledge topics, "culturally different health belief models" was the least to be addressed extensively, with only eight schools reporting that this topic was extensively addressed. Among skills and attitude topics, Limited English Proficiency (LEP) was the topic addressed in the least depth; only seven schools reported they addressed LEP extensively (Figure 1).

View larger version (29K): [in this window] [in a new window]   Figure 1. Distribution of responses to how extensively each area is addressed in dental schools’ cross-cultural curricula (n=38)

View larger version (19K): [in this window] [in a new window]   Figure 2. Facilitating and impeding factors reported by schools for inclusion of cross-cultural issues

Faculty expertise made the top three lists as both a facilitating and impeding factor for addressing cross-cultural issues at dental schools. Schools reported financial resources (i.e., grants) as the least important reason to include cross-cultural issues in the curriculum, yet it was reported by schools as the second most important reason for not devoting more time for teaching cross-cultural issues.

Table 3 summarizes the relationship of several variables to schools having formal cross-cultural curricula. There was no statistically significant difference in the proportion of schools that have formal cross-cultural curricula by the percentage of minority designation of their students, patients, or faculty. However, there was a statistically significant relationship between student minority percentage and faculty minority percentage (r=0.73, p<0.0001), indicating a strong positive correlation between these two groups. There were no statistically significant differences in the proportion of schools having formal cross-cultural curricula by either location, type of school, or total score on content areas. However, the number of clock hours devoted to cross-cultural issues in the curriculum was statistically significant (p=0.02).

	Discussion

Top Abstract Methods Results Discussion Conclusions and Recommendations Appendix References

 
With the rapid influx of immigrants and change in demographics, coupled with the slow change in diversity of dental graduates, there is a need to educate the available workforce to better address the needs of this diverse society. While cultural competence is a continuum, dental schools might be the first and only place where students are made aware of cultural issues and trained to better serve patients. Dental students have perceived the importance of diversity exposure and training.²⁴ Having a culturally diverse environment at dental schools could influence students’ perceived abilities in working with diverse populations. Hence, the importance of recruiting and retaining underrepresented minority students has been emphasized by the American Dental Education Association.²⁵ Increasing the percentage of minority dentists is believed to be one method to reduce barriers to access to care. However, the preponderance of minority patients will still be seen by the white majority of dentists in the near future;^26,27 thus, it is essential to prepare those dentists to be culturally competent.

This study showed that more schools reported having a formal cross-cultural curriculum (twenty-nine) than those that did not (sixteen). However, similar to medical schools,^18,19 there is a lack of uniformity among dental schools concerning teaching and evaluation methods. Efforts should now focus on developing research-based, explicit standards that specifically guide dental schools to effective approaches to teach cross-cultural issues. While there is no single "right" way to teach cross-cultural issues, the literature provides some guidance (e.g., Culturally and Linguistically Appropriate Services [CLAS] standards,⁹ Institute of Medicine report,² and American Medical Student Association [AMSA] project¹⁰). Using guidelines from other health professions that appear to be more advanced than the dental profession in cross-cultural competency education, formal, detailed curricular standards can be tailored for dental education. Collaboration and exchanging expertise with other health field professions are of paramount importance at this stage. In the absence of standardized dental curricular guidelines, modifying and adapting other health care professions’ proposals could be a step toward developing formal dental guidelines.

There is no clear guidance about when cultural issues should be best addressed in the curriculum. Some have proposed that, since cultural competence is a continuous process, it should be taught throughout all years of training.⁹ Others have suggested that it is vital that students learn about cultural competence early in their professional education.¹⁰ Most of the responding schools (71 percent) report that cross-cultural issues are addressed during at least one of the preclinical years and again during one of the clinical years. This would seem to ensure that students have opportunities to apply the knowledge and skills learned in their preclinical years in dental school. This structure would also provide the faculty with opportunities to evaluate students’ learning over time.

The extent of teaching specific topics in the dental curricula also seemed to be affected by the format of how cross-cultural issues were addressed in the curricula. Schools that addressed cross-cultural issues in a separate course had significantly higher scores on all content areas (i.e., addressed these topics more extensively) than schools that had them integrated with other courses. Schools integrating cross-cultural issues with other courses but have specific cross-cultural goals and objectives also had higher mean scores than schools that integrate them with no specific objectives in the curricula. This suggests that schools that had implemented a formal approach to teaching cross-cultural issues were more likely to address these topics in detail. The study also showed a positive correlation between the clock hour time devoted to cross-cultural issues and the extent schools taught these topics. This result is expected since presumably dental schools would not be increasing clock hours without addressing the topic in more depth. The study showed a statistically significant difference between schools having formal cross-cultural curriculum and those that don’t by the number of clock hours devoted to it. Consequently, formal format or approach—whether in a separate course or integrated—seems to predict that cross-cultural issues will be addressed in depth.

Dental schools seem to be similar to medical schools in addressing language issues in that the topic is not addressed in depth in the curricula.²⁰ Limited English proficiency is an emerging health field concern and will require more attention.Having a diverse patient population was the most frequently reported reason for addressing cross-cultural issues. It appears that dental schools are aware of the needs of their patient population and are trying to respond to some of those needs by inclusion of cross-cultural education in their curricula.

The most frequently cited challenge against inclusion of cross-cultural curricula was that there is not enough time in an already crowded curriculum. Others have acknowledged that dental curricula are overburdened and that it would be a challenge to add cross-cultural education.²⁸ Dental school administrators will need to make some difficult decisions in establishing curricular priorities. Without committed leadership, which was one of the top three reasons for including cross-cultural issues in the curriculum, cross-cultural education will not go beyond the stage of "talk the talk."

Financial resources may be an impediment to initiate curricular activities for cross-cultural training. However, schools funded through the Robert Wood Johnson Foundation pipeline grant not only have removed this obstacle, but they have specifically promoted inclusion of cross-cultural issues in their curricula. Although financial resources were the least reported reason for inclusion of cross-cultural issues among the choices offered in the survey, it was one of the top three reported reasons for not devoting more time to these issues. Policymakers need to consider incentives if they are to advocate for more cross-cultural education at dental schools.

Faculty expertise/interest was the only commonly listed item among the top three factors for both facilitating and impeding factors. This is an important indicator of the need for experts and trained faculty in cultural competence so that they can incorporate appropriate information in didactic and other clinical educational situations. Dental schools could overcome this challenge by arranging for faculty workshops, seminars, and conferences and by acknowledging its importance in promotion and tenure. Cross-cultural expertise can be supported by encouraging faculty development in this field. Examples of successful programs should be shared with other institutions.

The goal of cross-cultural education is to provide students with the knowledge, skills, and attitudes that will help them to communicate and provide care to their patients. There is little documentation regarding the most effective educational interventions. Currently, educational interventions have been shown to increase people’s knowledge and skills,¹⁴ but there is a dearth of published evidence that links specific interventions to any patient outcomes. Curricular guidelines need to be established that are based on scientific research. A set of core competencies for cross-cultural education should be developed so that schools can work toward common goals in addressing patients’ needs.

Limitations of these findings include the following: 1) while the response rate to the survey was about 80 percent, the remaining schools may or may not be similar; 2) the accuracy of the responses is uncertain, especially since many faculty may have been involved in its institutional response; 3) the structure of the survey questions may have limited some responses about the content and depth of cross-cultural exposure in their curricula; 4) the operational definitions used and the narrow focus (i.e., race and ethnicity) may underestimate the number of institutions that are providing cross-cultural education about other issues (e.g., socioeconomic, age) not covered in this survey; 5) some institutions do not maintain information about race/ethnicity in their databases; 6) schools were limited to seven content areas that were considered fundamental in any cross-cultural course;^2,9,10 7) using a summative score may unfairly assign equal importance to each of the seven content areas; and 8) the survey did not address the sequencing of the curricular components relating to cultural competence. Moreover, the survey restricted cross-cultural education to "didactic" teaching only, so clinical opportunities for addressing cross-cultural issues are not covered. Most schools reported less than 50 percent of the students, patients, and faculty were a racial/ethnic minority. However, our analysis included all of the responding institutions, regardless of racial/ethnic mix, because of the importance of having information from each institution. Such inclusion, however, did not appear to impact any of the statistically significant findings.

	Conclusions and Recommendations

Top Abstract Methods Results Discussion Conclusions and Recommendations Appendix References

 
In this, the first known descriptive study of cross-cultural education in U.S. dental schools, a high percentage of schools (80 percent) reported that they address cross-cultural issues formally in their curricula. Seventy-eight percent of surveyed schools use multiple educational methods, and 71 percent of schools address cross-cultural issues during at least one year of preclinical and one year of clinical education. Clearly, most dental schools are making efforts to integrate cross-cultural issues into their curricula. However, the variation in teaching and evaluation methods used, the format of the curricula, and the extent or depth of curricular content all imply the need for more uniform guidelines.

The variable of clock hours was a significant predictor for having formal cross-cultural curricula. It was also significantly correlated with the extent/depth of the content of the curricula. Schools that address cross-cultural issues formally tend to spend more time and have depth in their curricula on cross-cultural issues.

Based on the findings reported here and our experience with implementing a cross-cultural curriculum, we believe the following activities are likely to help foster future dentists who are culturally more aware to provide care for a diverse patient population:

• schools should continue efforts to recruit minority students and faculty to provide a culturally diverse environment for students and provide a workforce that is representative of the diverse population;
  
• dental schools should collaborate with other health professions schools to develop similar curricular competency objectives and methods;
  
• schools that are developing new teaching and evaluation methods should share their information;
  
• a curriculum task force should be created from committed leaders to develop guidelines or principles to address cross-cultural issues;
  
• schools should reassess their curricular priorities and find ways to incorporate cross-cultural issues formally (whether in a separate course or integrated) and address barriers to inclusion; and
  
• research that explores strategies for effectively teaching cross-cultural issues should be encouraged.
  

	APPENDIX

Top Abstract Methods Results Discussion Conclusions and Recommendations Appendix References

 
Cross-Cultural Education in U.S. Dental Schools Survey

1. Give the approximate percentage of predoctoral students from the following racial/ethnic groups in your dental school:

   _______ Caucasian/European descent
   

   _______ African-American
   

   _______ Hispanic/Latino
   

   _______ Asian
   

   _______ American Indian
   

   _______ Other
   

   100%
   

   
   
2. Give the approximate percentage of patients visiting the school clinic facilities from the following racial/ethnic groups:

   _______ Caucasian/European descent
   

   _______ African-American
   

   _______ Hispanic/Latino
   

   _______ Asian
   

   _______ American Indian
   

   _______ Other
   

   100%
   

   
   
3. Give the approximate percentage of faculty present at your dental school from the following racial/ethnic groups:

   _______ Caucasian/European descent
   

   _______ African-American
   

   _______ Hispanic/Latino
   

   _______ Asian
   

   _______ American Indian
   

   _______ Other
   

   100%
   

   
   
4. How are cross-cultural issues addressed didactically at your school?
   Check all that apply:

   Addressed in a separate, independent course
   

   Integrated with other course(s), with specific goals, objectives, and evaluation
   

   Addressed with other course(s), without specific goals, objectives, and evaluation
   

   Not part of the curriculum (skip to question 12)
   

   
   
5. During which year(s) are cross-cultural issues addressed?
   Check all that apply:

   1^st year
   

   2^nd year
   

   3^rd year
   

   4^th year
   

   
   
6. What are the methods of teaching cross-cultural issues in your school?
   Check all that apply:

   Didactic (lectures/seminars)
   

   Case studies
   

   Problem-based learning
   

   Small group discussions
   

   Roleplay exercises
   

   Presentations by community members
   

   Other: ____________________________
   

   
   
7. How are students evaluated for cross-cultural content in the curriculum?
   Check all that apply:

   Written exams (multiple choice, pretest-posttest, etc.)
   

   Oral presentation
   

   Objective Structured Clinical Examinations (OSCEs)/standardized patient assessment
   

   Reflective journal
   

   Direct observation of students’ skills and attitudes
   

   Other: ___________________________________
   

   ______________________________________________
   

   No specific form of evaluation is done.
   

   
   
8. Relative to other schools, how well does your school address the following issues:
   Use a scale from 0–3:

   0=not addressed at all
   

   1=minimally addressed
   

   2=moderately addressed
   

   3=extensively addressed
   

   _______ Definitions and/or concepts of culture, diversity, ethnicity, and cultural competency
   

   _______ Concepts of culturally different health beliefs models
   

   _______ Access issues
   

   _______ Oral health disparities
   

   _______ Communication and interviewing skills of culturally different populations
   

   _______ Issues related to limited English proficiency of patients
   

   _______ Awareness and respect of culturally different groups
   

   
   
9. Overall, how much time (i.e., clock hours) do you think is spent didactically on addressing cross-cultural issues at your school?

   Less than five hours
   

   From 5–10 hours
   

   From 11–20 hours
   

   From 21–30 hours
   

   From 31–40 hours
   

   More than 40 hours
   

   
   
10. What do you think are the three most important reasons why you address cross-cultural issues at your school?
    (1=most important, 2=second most important, 3=third most important)

    _______ Financial resources (i.e., grants, contracts, etc.)
    

    _______ Leadership commitment
    

    _______ Students’ interest/request about this subject
    

    _______ A diverse patient population
    

    _______ Faculty expertise/interest
    

    _______ Other: ______________________________________________
    

    
    
11. What do you think are the three most important reasons why your school doesn’t devote more time to cross-cultural issues?
    (1=most important, 2=second most important, 3=third most important)

    _______ Competing curricular time
    

    _______ Limited financial recourses
    

    _______ Lack of leadership commitment/interest
    

    _______ Lack of students’ interest
    

    _______ Lack of patients’ diversity
    

    _______ Lack of faculty expertise/interest
    

    _______ Other: __________________________________________
    

    
    Questions 12 through 16 relate to outreach or extramural programs (service learning)
    
12. In what type of community outreach/extramural programs do your students participate? Check all that apply:

    Public health clinics
    

    Community health centers
    

    Mobile units
    

    Hospital clinics
    

    Private dental offices
    

    Other: _________________________________
    

    Institution does not have such a program (go to question 17)
    

    
    
13. How much time is spent by students in extramural/outreach programs? Please record the appropriate number in one of the two boxes below:

    weeks
    or
    days
    

    
    
14. Is cultural awareness/sensitivity one of the stated objectives for the extramural/outreach programs?

    Yes
    

    No
    

    
    
15. Prior to participation,
    1. how are students provided information about the community’s oral health needs?

       Handouts, containing needs assessment
       

       Lecture/presentation at dental school/site by instructor
       

       Presentation from community member
       

       Other ___________________________________________
       

       None
       

       
       
    2. how are students provided information about the cultural background of the targeted community?

       Handouts containing demographic information
       

       Lecture/presentation by instructor
       

       Presentation from community member
       

       Other ____________________________________________
       

       None
       

       
       
    
    
16. How are students evaluated on providing culturally sensitive care during their extramural/outreach experience?

    Pretest-posttest questions
    

    Reflective journals of students
    

    Observation by onsite faculty/director
    

    Feedback from site director
    

    Other ____________________________________________________
    

    No specific form of evaluation is done.
    

    
    
17. During the past five years, has teaching cross-cultural issues at your school:

    Increased?
    

    Decreased?
    

    Remained the same?
    

    
    
18. Please feel free to provide additional comments about how your institution is addressing cross-cultural issues.
    ________________________________________________________________________________________________________________________________________________________________________________________________________________________
    

Thank you for completing the survey. Please return it in the self-addressed envelope.

Linda Saleh, BDS

Preventive & Community Department

N332 DSB

University of Iowa

College of Dentistry

Iowa City, IA

	Footnotes

 
Dr. Saleh is a Graduate Student in Dental Public Health; Dr. Kuthy is Professor and Chairperson, Department of Preventive and Community Dentistry; Dr. Chalkley is Associate Dean for Students and Curriculum, Admissions, and Financial Aid; and Prof. Mescher is Associate Professor, Department of Preventive and Community Dentistry—all at the University of Iowa College of Dentistry. Direct correspondence and requests for reprints to Dr. Raymond A. Kuthy, Department of Preventive and Community Dentistry, N336 DSB, University of Iowa College of Dentistry, Iowa City, IA 52242-1010; 319-335-7201 phone; 319-335-7187 fax; raymond-kuthy{at}uiowa.edu.

	REFERENCES

Top Abstract Methods Results Discussion Conclusions and Recommendations Appendix References

 

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