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The Pipeline Program at the University of Connecticut School of Dental Medicine

Direct correspondence and requests for reprints to Dr. Pamela L. Davidson, UCLA School of Public Health, Box 951772, 31-269 CHS, Los Angeles, CA 90095-1668; 310-825-7188 phone; 310-825-3317 fax; PDavidson{at}mednet.ucla.edu.

Key words: case study, community-based dental education, minority student recruitment, curricular change, extramural rotations, dental care access

This chapter presents an overview of the Pipeline, Profession, and Practice: Community-Based Dental Education program as it was conducted at the University of Connecticut School of Dental Medicine from 2002 to 2007. Pipeline programs, sponsored by the Robert Wood Johnson Foundation and The California Endowment, were carried out at select dental schools across the United States during this period, with the objectives of increasing recruitment and retention of underrepresented minority/low-income (URM/LI) students, revising the curriculum to prepare more culturally competent dentists, and expanding community-based clinical experiences; these objectives are directed toward the ultimate goal of increasing access to dental care for underserved populations. The case studies on each school are written by National Evaluation Team investigators who evaluated the program and are based on multiple data sources and site visits.

Table 5.0.1. in the introduction to the fourteen case studies provides a snapshot of the University of Connecticut School of Dental Medicine in comparison with the other schools in the Pipeline evaluation, using a set of uniform measures to characterize the Pipeline dental schools.¹ The evaluation framework and methods used for data collection and analysis are described in Chapters 3 and 4 of this report.^2,3

After a brief overview of the history of the school and its environment, this chapter summarizes the major outcomes of the school’s Pipeline program in the areas of URM/LI student recruitment, curricular changes, and extramural clinical rotations. Comments on the program written by representatives of the dental school follow the description of outcomes.

	History and Context: The School and Its Environment

Top Author information History and Context: the... Urm/li recruitment Curricular changes Extramural clinical rotations Major conclusions References

 
The University of Connecticut School of Dental Medicine is the only public dental school in New England, and its tuition is extremely reasonable compared to other institutions in the area. Modeled on the Harvard School of Dental Medicine, the University of Connecticut dental school was built in the 1980s, and it functioned as a "school on a hill" in two senses. Literally, the schools of Dental Medicine and Medicine, along with the John Dempsey Hospital, are located in one unified structure atop a hill seven miles west of Hartford in Farmington. But since its inception, the school has also been a prominent leader in dental education, research, and patient care—thus serving as a model and beacon for academic dentistry. With power and resources allowing it to work within its own walls, the school had been successful in building, recruiting, achieving good results, and maintaining small class size. Interacting with community dentists or with the community at large had not been seen as a priority. However, nearly a decade ago and prior to the Pipeline program, the administration decided to expand into greater Hartford, where satellite clinics were established and community dentists were recruited as faculty. At the beginning of this expansion, the university-based faculty went through an adjustment period, which was particularly challenging for those who experienced the early resource-rich yet insular years. In contrast, the incoming new faculty adjusted quickly and favorably to the new context. Described as a "whole culture shift," it was within this context that the dental Pipeline program was launched in academic year 2002–03.

The University of Connecticut School of Dental Medicine (UConn-SDM)’s strategy for its Pipeline program was to channel its care delivery capacities to targeted areas of need to respond to the dental care access problem. At the onset, several major advantages for the school in conducting the program were identified: 1) the school is located in a relatively small state; 2) the need is concentrated in urban communities; and 3) participants would have a one-hour commute or less from the school to deliver community-based dental care. Consequently, faculty, residents, and students would be able to address the needs of the state’s most underserved populations without incurring major costs for travel and housing. It was also an advantage that well-equipped but underutilized federally qualified health centers (FQHCs) were already established in several of the surrounding communities. Through partnership agreements with these FQHCs, the UConn-SDM planned to delegate responsibility for infrastructure and operations while dedicating school resources, including grant funds, directly to the core Pipeline program objectives of URM recruitment and service delivery.

In the 2003–04 academic year, a new principal investigator (PI) and support staff were hired to assume the responsibility for implementing the Pipeline program. That same year the Office of Community and Outreach was established to work with the current community health centers and to identify additional ones. Both hiring the new PI and establishing this office were instrumental in carrying out short- and long-term recruitment and retention strategies for the UConn-SDM and gaining faculty acceptance of and trust in the Pipeline program.

Compared to other states, Connecticut is small, permitting travel anywhere in the state within an hour and a half or less. But, although Connecticut is also the wealthiest state per capita, it contains some of the poorest cities. These inner-city poverty zones experience high infant mortality rates and large percentages of children born to unwed mothers. In 2000, infant morality rates for African American and Hispanic children in Connecticut were 2.8 times and 1.6 times higher, respectively, than for white non-Hispanic children.⁴

Although affluent Connecticut has a high per capita income and a relatively large number of dentists, it suffers from a severe and growing problem of lack of access to oral health care services. The distribution of dentists is uneven, generally clustered in the affluent communities, and reflects the wealth map of the state. Dental care discrepancies are largely confined to Connecticut’s five largest cities (Hartford, Bridgeport, New Haven, New Britain, and Waterbury), which are classified amongst the nation’s poorest and most ethnically diverse.

Financing for public services in the state has been perceived as good. However, few of the children and adolescents covered by the state’s Medicaid and SCHIP programs receive dental treatment. Due to low Medicaid reimbursement rates in Connecticut, less than 15 percent of the state’s dentists participate in Medicaid. The problem is underscored by the fact that 54 percent of the Medicaid enrolled children reside in these large urban areas where only 18 percent of the dentists practice. At the onset of the Pipeline program, UConn-SDM leaders considered the safety net services offered by the school, while helpful, to be insufficient and needing to be expanded.

At the beginning of the Pipeline program, the oral health care access crisis was well known in the state and to its citizens. Dental care access had received considerable attention in the legislature and the media, and public interest and advocacy groups continued to press for timely, effective solutions. Consequently, there were incentives for all constituencies—dental school, government agencies, foundations, professional organizations, and community groups—to consolidate resources to formulate new corrective strategies. In many ways, as this case will reveal, the University of Connecticut was playing a leadership role in the effort to address the access crisis.

	URM/LI Recruitment

Top Author information History and Context: the... Urm/li recruitment Curricular changes Extramural clinical rotations Major conclusions References

 
At the onset of the Pipeline program, the University of Connecticut Health Center’s Office of Health Careers Opportunity Program (HCOP) coordinated the recruitment of minority students for both the dental and medical schools. HCOP has gained national recognition for innovative programs that include both short-term and long-range strategies to enhance minority student enrollment in the health professions. The Pipeline program coincided with an HCOP initiative to identify students early in the "education pipeline" and develop mentoring and support programs to increase dental school matriculation rates. Through the HCOP office, the School of Dental Medicine offered, in conjunction with the School of Medicine, the following URM/LI recruitment approaches: 1) Medical/Dental Preparatory Program, 2) College Enrichment Program, and 3) the Bridge to the Future Mentoring Program, which provides mentoring and leadership opportunities for first- and second-year dental students. At baseline, recruitment efforts also included partnerships with historically black colleges such as Morehouse, Spelman, and Morris Brown. Partnerships also extended to the Urban League and local dental societies. Long-term recruitment strategies placed emphasis on dental care awareness for middle and high school students participating in collaborative programs of the HCOP and Hartford School District. Despite these efforts, enrollment of African American and Hispanic students at the dental school had remained low. In the 2002–03 academic year, the entering class had two African Americans and no Hispanic students out of a total of forty-three enrolled students.

Changes in the Recruitment Process
At the time of the interim site visit, the school had developed and pursued recruitment strategies through the following means: 1) HCOP Health Professions Partnership Initiative, 2) W.K. Kellogg/American Dental Education Association (ADEA) Access to Dental Careers grant, 3) Pipeline Health Professions Summer Academic Institute (PHPSAI), and 4) African American Fraternities Health Professions Mentoring Initiative. Additionally, a predental society was created at the University of Connecticut–Storrs undergraduate campus in the spring of 2004. The dental school’s dean of admissions serves as an advisor to the club.

In 2004, the UConn-SDM developed and implemented the PHPSAI with reallocated Robert Wood Johnson Foundation (RWJF) funds, and the institute turned out to be a very successful recruiting activity. This annual summer program is a six-week academic enrichment program involving a Dental Admission Test (DAT) preparatory course, a review of basic sciences and current issues in dentistry, visits to local community health centers, and shadowing practitioners.

In addition, a dean of community outreach programs (an African American) was hired to improve the recruitment of URM/LI students and to serve on the Admissions Committee. The dean attended all the senior group meetings and was active in discussions regarding URM/LI applicants. This was a new position for the school and represented a restructuring on the part of UConn-SDM. Since only part of the Pipeline funding went into this position, the school covered a large portion of this dean’s salary, demonstrating UConn-SDM’s commitment to the Pipeline goals. The Admissions Committee also includes another African American and a Hispanic faculty member.

Another major change mentioned by a senior administrator is the increasing focus on recruiting from within the state: "Through some interface with the legislature, we were hearing requests to concentrate a bit more on in-state recruitment. Not a directive, but just enough comments that we decided that we would." Along with attempting to meet the Pipeline objectives related to URM/LI recruitment, the school aims to recruit approximately 60 percent of the entering class from within Connecticut. Additionally, by working directly with feeder schools out of state, including Morehouse, Spelman, and Morris Brown, they hope to more adequately represent the demographics of the state in terms of the student body.

Figure 5.5.1 shows a considerable increase in the URM applicants and enrollees at UConn-SDM over the course of the Pipeline program. The number of URM students in the entering class grew from two in 2003 to eleven in 2006. The 2006 entering class consisted of six African Americans and five Hispanic students. Table 5.5.1 shows an increasingly diverse student body, from twelve URM students enrolled at UConn-SDM in 2003 to twenty-six URM students enrolled in 2006. However, there was a substantial reversal in URM admissions during the last year of the Pipeline program with only one URM student enrolling.

View larger version (7K): [in this window] [in a new window]   Figure 5.5.1. URM applicants (green) and first-year enrollees (red), 2002–07: University of Connecticut School of Dental Medicine Sources: Data from school’s implementation reports for 2003 through 2007. Updated applicant number for 2005 from email communication with academic administrator 5/19/06. Updated applicant number for 2007 from email communication with academic administrator9/5/07.

An academic administrator described some major changes that have occurred since the Pipeline program: "Previously, we were doing admissions the same way we were doing it twenty years ago." This administrator claimed that, partly as a result of meetings and workshops offered by RWJF and the College Board for the UConn-SDM faculty, there is now heightened awareness related to minority issues in terms of admissions. The College Board is a nonprofit organization whose mission is to connect high school and college students with educational institutions. As a result, the administrator said, "The Admissions Committee does not only look at primarily the numbers but looks at all the aspects of an applicant’s profile. I think it’s just made it more comprehensive."

Sustainability of Recruitment Efforts
RWJF funds are no longer available to sustain PHPSAI recruiting activity. However, the SDM will continue to hold its summer medical/dental preparatory program through the HCOP office and is considering offering an additional one-week intensive workshop to expose students to the application process and various dental experiences. Funding for this one-week summer enrichment will come directly out of the UConn-SDM budget. The school also plans to continue collaborating with the School of Medicine to recruit URM students. Resources, programs, and personnel are shared between the two colleges, but competition for qualified URM students can sometimes occur. The HCOP Health Professions Partnership Initiative office will also continue to manage recruitment efforts. According to a senior administrator, the HCOP office is very well funded and supported by the UConn Health Center. Additionally, academic and senior administrators will continually be involved in networking statewide in order to build relations with minority practitioners. However, funding for the dean of community outreach programs was cut after the Pipeline program ended. The African American employee occupying this position helped make possible significant increases in URM recruitment. As of our last site visit, her future at UConn-SDM was unknown.

	Curricular Changes

Top Author information History and Context: the... Urm/li recruitment Curricular changes Extramural clinical rotations Major conclusions References

 
UConn-SDM defines itself as a research-focused school and takes pride in its excellent student scores on the dental board examinations. At baseline, the curriculum was described as "fully loaded," and dental students participated with medical students in a unified Basic Medical Sciences (BMS) curriculum in Years 1 and 2. Additionally, dental students pursued the Correlated Dental Sciences (CDS) curriculum in Years 1 and 2, which prepares them for patient care experiences in Years 3 and 4. Under the Pipeline program, CDS (which continues through Years 3 and 4) was expanded to include new courses addressing special needs patients, health policy, and multiculturalism.

In January 1999, the faculty approved a comprehensive Curriculum Revision Project to significantly revise the predoctoral curriculum over the period of 2002–04, including a major goal to "place increased emphasis on community service by increasing the component of the curriculum delivered through community-based activities." The planning year for the Pipeline program (2002–03) conveniently coincided with the planning year for the new senior year curriculum.

Two major structures provide oversight and management of the UConn-SDM curriculum. The Curriculum Management Committee (CMC) is the administrative subcomponent of a larger Curriculum Committee. The associate dean for academic affairs oversees the CMC. The second structure is the faculty. Consistent with any dental school or academic institution, the faculty administers the curriculum and has domain over its direction and policies.

Highlighted CBDE Courses
At baseline, the UConn-SDM faculty had just completed a major restructuring of the curriculum. The curriculum had been revised into eight thematic areas with courses spread over the four years. The eighth component incorporates the community-based dental education (CBDE) curriculum.

Table 5.5.2 shows the changes in the CBDE curriculum from baseline to the culmination of the Pipeline program. The relevant CBDE curriculum at baseline included SDM D2 sections on culture and health care, and shared the D2 curriculum with the medical and dental students on human development and biopsychosocial framework of health and illness. The mentoring program, which was in place before the Pipeline program for D1 through D4 students, was continued throughout the Pipeline program years with increased opportunities for students with mentors representing culturally diverse patients. A main objective of the ongoing mentoring program is to recruit more minority dentists to serve as preceptors. The faculty mentor assigned to the student is responsible for evaluating his or her interpersonal interactions with patients. By the culmination of the Pipeline program, the new or revised D3 and D4 curricula included courses or modules in geriatric and special needs dentistry, public health care policy, culture and dental care, and community health center-based practice management.

In addition to these three new courses, a new Community Health Clinic (CHC) Rotation Orientation session was created for the D4 year. The CHC orientation session is a one-hour introduction to the extramural community rotations to help prepare students about what to expect and what is required of them. The community health care rotation is graded pass/fail. Students are required to attend the scheduled pre-rotation session, receive a satisfactory evaluation from the CHC faculty, and complete and turn in a reflections paper or a post-rotation evaluation. Student reflections were included during the 2004–05 evaluation process. Satisfaction surveys of faculty and students regarding the various rotation settings and experiences were expanded in subsequent years to evaluate participating CHC rotation sites. The CHC rotations include seven sites where students spend a minimum of fifteen days, with the ability to add more days through the Selective Program following the required CHC rotations (described below).

One senior administrator stated the faculty members are able to emphasize or model communication skills and treatment of culturally diverse patients because UConn-SDM’s patient population is exceptionally diverse in terms of ethnic and cultural backgrounds, socioeconomic status, age, and health status. In contrast, the senior dental students felt clinical faculty modeling of culturally competent behavior was generally limited and most of the instruction was received in the didactic courses, for example, the Patient-Instructor Module. The fourth-year students interviewed generally agreed that modeling goes on in the classroom and not particularly in the clinic setting at the university or even in the CHCs. A clinical faculty member explained it this way: "In the clinical environment, I know we see so many diverse patients, and the faculty try to ask the students to dive a little deeper beyond just the technique that they are doing. For example, if the student had a cancellation or a no-show, well, why you think that patient didn’t show? Do you think it had anything to do with transportation issues or where they are coming from?"

Academic performance and promotion committees evaluate and assess the students in several areas, including professionalism, practice management, communication skills, awareness, and competence in treating individuals from diverse backgrounds. Additionally, students are assigned a faculty member who is specifically responsible for evaluating the students’ interpersonal interactions. Furthermore, the community-based adjunct faculty members assist with the students’ preparation by discussing the cultural competence needs of the diverse clients served at the facilities.

Sustainability of Curricular Changes
The bimonthly dental directors’ meetings continue to provide feedback on the curriculum. Also, according to the faculty, there is commitment on the part of the administration and faculty to stay on course with the changes made to the curriculum, especially regarding the PI program. The PI module has been accepted into the curriculum and expanded to include third-year students. With support from the dean, the administration also voted to continue this aspect of student training, after the Pipeline funding ends, by including a modest cost in student fees. In addition, there is a fee involved with renting the clinical skills assessment lab, which will also be passed on to the students. According to a senior administrator, curricular changes from the Pipeline program have been well established and will be continued. There is institutional support not only for the PI course but for other didactic and clinical initiatives supported by the Pipeline program.

	Extramural Clinical Rotations

Top Author information History and Context: the... Urm/li recruitment Curricular changes Extramural clinical rotations Major conclusions References

 
The University of Connecticut is the major Medicaid dental provider to the state. According to senior administration, the dental school provides over 30 percent of the care Medicaid children in Connecticut receive. For mentally or otherwise disabled adults, the school is almost the sole source of care: at least 62 percent of all the care these patients receive is from the SDM residents. Over half the patients in the dental school are adult Medicaid recipients, and 82 percent of the children cared for in the clinics are Medicaid recipients. Now, with the school’s connections to the community health centers, it is a major safety net provider.

The clinical objective of the UConn-SDM Pipeline program was to provide additional, new community-based clinical care experiences for predoctoral dental students and advanced education in general dentistry (AEGD) residents. These experiences or tracks were designed to expose students to different communities and populations, access to care problems, and health delivery models. The school proposed that all students participate in forty-seven days of Core Community Experience provided through four tracks: Pediatric Dentistry at Burgdorf Health Center (twenty days), CHC-Comprehensive Care (twenty days), Urgent Care-AEGD (three days), and Surgical Care at Hartford Hospital (four days). Three tracks were already established, while the fourth, CHC-Comprehensive Care, was to be implemented through the Pipeline program. The Pediatric Dentistry-Burgdorf Health Center track would occur over Years 3–4 while all other tracks would occur exclusively in Year 4.

Changes in the Clinical Services Program
The school’s two established programs—the service-oriented program in pediatric dentistry and AEGD resident activity within regional FQHCs—were used as models for expanding community service activities for predoctoral students. At the time of the baseline site visit, the clinical outreach program was fully implemented in the inner city of Hartford. Following the AEGD program, predoctoral students are sent to CHCs where there is an AEGD resident. The program to fulfill the sixty-day extramural rotation for the Core Community Experience was on track. The predoctoral students were sent to the two CHCs for a total of six days. There was also a strategic plan in place to increase the number of CHCs to eight sites by the fourth year of the Pipeline program. Also at the baseline visit, faculty members expressed concern about extramural rotations, but there was growing acceptance and support for them. Students strongly supported the rotations.

The following describes the clinical rotation program for predoctoral students at the time of the interim site visit:

• Core Community Rotations
  
• 20 days: pediatric dentistry at Burgdorf Health Center (third- and fourth-year students, for ten days each year)
  
• 3 days: urgent care-AEGD
  
• 4 days: surgical care at Hartford Hospital
  
• New CHC Rotations
  
• 2003–04: added six days at two sites: Charter Oak Health Center and Community Health Center of New Britain.
  
• 2004–05: added nine new days for a total of fifteen days at seven community sites: East Hartford Community Healthcare, United Community and Family Services, Charter Oak Health Center, Community Health Center of New Britain, Staywell Healthcare, and two private practices.
  

The selection of a community experience was based on student interest in a particular discipline and the availability of sites to satisfy student selections. Available sites include private offices, community health centers, and geriatric special care facilities. Table 5.5.3 shows that the average number of days in core community rotations experienced by fourth-year students at the time of graduation had increased considerably from twenty-seven days in 2002–03 to forty-two days in 2006–07. On this table, we see the number of extramural facilities located in urban settings has increased from two at baseline to eight in the final year of the program and the number of FQHCs increased from two to four.

View larger version (11K): [in this window] [in a new window]   Figure 5.5.2. Senior students’ perceptions of extramural (EM) rotations, by percentage of total respondents at the University of Connecticut School of Dental Medicine Sources: Data from ADEA surveys of dental school seniors. UConn’s response rates (and number of surveys returned) for the following years are as follows: 2003=100% (n=32); 2004=97% (n=34); 2005=100% (n=35); 2006=98% (n=44); 2007=100% (n=36).

On the other hand, a challenge to student rotations was the concern by the internal faculty regarding the community clinics. Specifically, concerns were raised about the types of procedures to which the students were exposed and the quality of care that is delivered in the community health centers. According to a senior administrator, "There are some really superb facilities in our community, and they have tried to meet and integrate with these community health centers. One of the directors of the CHCs was a graduate of our program that everyone admired." Throughout the period of the Pipeline program, strategies were developed by internal faculty to gain acceptance of the CHCs. For instance, the CHC doctors are periodically invited to campus to explain their expectations of the students regarding operative treatment. These interactions lead to a tremendous exchange of information among internal and external department faculty.

Sustainability of Community-Based Programs
UConn-SDM has built the Pipeline predoctoral extramural rotation program on the success of its AEGD program. Predoctoral students are sent to FQHCs where there was already an AEGD resident. The school receives a training site for its students and residents, and the FQHC gets to keep the revenue generated by the residents and students. It seems the Pipeline program may not positively impact long-term sustainability. The FQHCs are heavily reliant on government funding for their revenues and, as such, are in a precarious position with recent Medicaid cutbacks. The large majority of patients at FQHCs are from non-commercial payers (93 percent at Charter Oak, for example).

Figure 5.5.3 shows no senior dental students planned to practice in community clinics or government service after graduation in the first three years of the program; the percentage of students with such plans increased to 16 percent in 2006 and 8 percent in 2007. The figure also shows that, from baseline (6 percent), increasing percentages of seniors planned to provide care to underserved minorities after graduation (ranging from 14 to 23 percent).

View larger version (11K): [in this window] [in a new window]   Figure 5.5.3. Senior students’ practice plans, by percentage of total respondents at the University of Connecticut School of Dental Medicine Sources: Data from ADEA surveys of dental school seniors. UConn’s response rates (and number of surveys returned) for the following years are as follows: 2003=100% (n=32); 2004=97% (n=34); 2005=100% (n=35); 2006=98% (n=44); 2007=100% (n=36).

	Major Conclusions

Top Author information History and Context: the... Urm/li recruitment Curricular changes Extramural clinical rotations Major conclusions References

URM/LI Recruitment
UConn-SDM has achieved a considerable increase in URM applicants and enrollees over the course of the Pipeline program. Throughout the initiative, the UConn-SDM team supported the recruitment efforts for underserved minorities and showed tangible signs of commitment to the objectives by establishing a Community and Outreach Office and the implementation of the successful Pipeline Health Professions Summer Academic Institute (PHPSAI). It also succeeded in creating a postbaccalaureate program with an emphasis on the DAT, study skills, and the basic sciences. Furthermore, the HCOP Health Professions Partnership Initiative Office, which has previously coordinated the recruitment of minority students for the dental and medical schools, is well funded by the UConn Health Center and will continue to manage recruitment efforts after Pipeline funding ends.

Curricular Revisions
As part of the Pipeline initiative, UConn-SDM set out to implement new community-based dental education courses including dental health policy and increasing students’ cultural sensitivity as dental providers. An innovative Patient-Instructor (PI) Module was introduced to address differences that can hinder patient-provider communication. Trained individuals from the community portray patients from diverse backgrounds and simulated clinical encounters. Students received immediate feedback from these PIs regarding their strengths and weaknesses in encounters and communication abilities with diverse patients. In addition, a new Community Health Clinic (CHC) Rotation Orientation session was created for the D4 year. The CHC orientation was a one-hour introduction to the extramural community rotations to help prepare students for what to expect and what is required of them in the community rotations.

Extramural Clinical Rotations
The UConn-SDM was well positioned to impact the short-term oral health status of its surrounding communities through expanding the delivery of community-based and culturally competent dental care. Through its revised curriculum and expanded extramural rotations, the school provided an environment where students could prepare to serve ethnically and culturally diverse patients. Although the sixty-day targeted goal of the Pipeline program was not achieved, the school did increase predoctoral core community rotation days from twenty-seven days at baseline to forty-two days by the culmination of the program. However, the long-term sustainability of the expanded community rotation program was unclear due to the FQHCs’ reliance on public funding.

	Author Information

Top Author information History and Context: the... Urm/li recruitment Curricular changes Extramural clinical rotations Major conclusions References

 
Dr. Davidson is Associate Professor, School of Public Health, University of California, Los Angeles, and Co-Principal Investigator of the National Evaluation Team for the Pipeline program; Dr. Thind is the Canada Research Chair in Health Services Research and Associate Professor, Schulich School of Medicine and Dentistry, University of Western Ontario, and Co-Investigator on the National Evaluation Team for the Pipeline program; Dr. Friedman is Dean of Academic Affairs, West Los Angeles Community College, and Co-Investigator on the National Evaluation Team for the Pipeline program; and Ms. Carreon is Research Associate on the National Evaluation Team for the Pipeline program. Direct correspondence and requests for reprints to Dr. Pamela L. Davidson, UCLA School of Public Health, Box 951772, 31-269 CHS, Los Angeles, CA 90095-1668; 310-825-7188 phone; 310-825-3317 fax; PDavidson{at}mednet.ucla.edu.

	REFERENCES

Top Author information History and Context: the... Urm/li recruitment Curricular changes Extramural clinical rotations Major conclusions References

 

1. Gutierrez JJ, Nakazono TT, Carreon DC, Andersen RM. Introduction to case studies of the pipeline programs at fourteen U.S. dental schools. J Dent Educ 2009; 73(2 Suppl):S52–S57.[Free Full Text]
2. Carreon DC, Davidson PL, Andersen RM. The evaluation framework for the dental pipeline program with literature review. J Dent Educ 2009; 73(2 Suppl):S23–S36.[Free Full Text]
3. Davidson PL, Nakazono TT, Afifi A, Gutierrez JJ. Methods for evaluating change in community-based dental education. J Dent Educ 2009; 73(2 Suppl):S37–S51.[Free Full Text]
4. Centers for Disease Control and Prevention. Infant mortality statistics from the 2004 period: linked birth/infant death data set. National Vital Statistics Reports 2007;55(14):1–32. At: www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_14.pdf. Accessed: June 1, 2007.
5. Wagner J, Arteaga S, D’Ambrosio J, Hodge CE, Ioannidou E, Pfeiffer CA, et al. A patient-instructor program to promote dental students’ communication skills with diverse patients. J Dent Educ 2007; 71(12):1554–60.[Abstract/Free Full Text]
6. Wagner J, Arteaga S, D’Ambrosio J, Hodge C, Ionnidou E, Pfeiffer CA, Reisine S. Dental students’ attitudes toward treating diverse patients: effects of a cross-cultural patient-instructor program. J Dent Educ 2008; 72(10):1128–34.[Abstract/Free Full Text]

Comments from the University of Connecticut School of Dental Medicine

This case study provides important documentation of the successes and challenges of the University of Connecticut School of Dental Medicine’s (UConn-SDM) Pipeline program.

Our Pipeline program has had a significant institutional impact, ushering in changes that will improve our academic and clinical programs, as well as increasing access to oral health care for Connecticut’s citizens.

Overall, the case summarizes the UConn-SDM story and our participation with the Pipeline program. Many of the sociocultural nuances are difficult to capture in this kind of evaluation process. As is stated in the case, Connecticut has the dual distinction of being the richest state and the state with the poorest cities in the nation. This dichotomy presents unique challenges. Access to dental care and dental education is often restricted to those of financial means—which represents a fairly racially homogeneous group. Thus, commitment to the principles of the Pipeline program was an opportunity for transformational changes that are significant and important.

There were a number of lessons learned during our five-year journey. Evaluation and feedback guided changes in how students were prepared for their clinical community experiences. The orientation is now an hour-long session with handouts that include comprehensive information on what to expect, the clinical and nonclinical objectives to achieve a passing grade, reporting of clinical procedures, and the importance of the rotation to students’ growth and development as future oral health care providers. The rotations were changed from block assignments (consisting of two days per week for eight weeks) to one day per week for half of the year, with a goal of changing the rotation to one day per week for the entire academic year. This change we anticipate will improve continuity of care, provide enhanced immersion of the student with the culture of the patient population, and simulate what could be possible in terms of devoting one day per week to community service once the students graduate and are in private practice. Having the ability to learn and use four-handed dentistry, unlike in the dental school clinics, was also a very important aspect of their experience.

Perhaps our greatest success was in changing the admissions process to incorporate the importance of the diversity any applicant can contribute to the class—be it gender, race, work experience, or cultural background. We have been able to increase diversity significantly at a time when the applicant pool for students of color applying to dental school is only slightly increasing. Given the structure of the curriculum (combined with the medical class for the first two years), our students must demonstrate academic rigor. We learned that this necessitates careful attention to the numbers in a whole-file review of applicants. Students of color who complete one of our summer enrichment programs have a higher attrition rate when they matriculate at UConn-SDM than do students who matriculate at dental schools with a more traditional curriculum. However, the good news is that the advancement of students completing the PHPSAI has been 100 percent for the sixteen students matriculating at dental schools nationwide.

In summary, the Pipeline program provided the UConn-SDM with the assistance needed to complete strategic plans around diversity and community-based dental education. The greatest threat to sustainability is funding for program management, which continues to be a challenge; however, there is no intent to reverse advances made to date. The administration remains committed to the ideals and principles of the Pipeline initiative, which have become part of the fabric of dental education at the University of Connecticut School of Dental Medicine.

This article has been cited by other articles:

				R. M. Andersen and P. L. Davidson Introduction to the Evaluating the Dental Pipeline Program Report J Dent Educ., February 1, 2009; 73(2_suppl): S10 - 14. [Full Text] [PDF]

				P. L. Davidson, T. T. Nakazono, A. Afifi, and J. J. Gutierrez Methods for Evaluating Change in Community-Based Dental Education J Dent Educ., February 1, 2009; 73(2_suppl): S37 - 51. [Full Text] [PDF]

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