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Chapter 6.1 |
Key words: underrepresented minority dental students, low-income dental students, career choice, dental student recruitment, health professions students
In this chapter, we will tell the story of how the Pipeline, Profession, and Practice: Community-Based Dental Education program affected the recruitment and retention of underrepresented minority (URM) dental students, beginning with how these students decide on dentistry as a career. We will then discuss the URM recruitment programs used by the Pipeline schools and their challenges and successes in these endeavors. Then, what follows is an analysis of the actual effects of the Pipeline program and other factors on the recruitment and retention of URM students. Since an initial but less emphasized purpose of the Pipeline program was to encourage the recruitment of low-income (LI) dental students, we will consider separately the recruitment of these students and how they differ from URM students. In addition, since a purpose of the Pipeline program—particularly for the California schools whose programs were funded by The California Endowment—was to encourage Pipeline schools to work collaboratively regarding URM recruitment, we will conclude this section with a description of those collaborations.
In comparing the dental schools, we will sometimes distinguish among three groups: 1) the National Pipeline schools, which are the ten dental schools across the United States that received funding to conduct Pipeline programs from the Robert Wood Johnson Foundation; 2) the California Pipeline schools, which are the additional four dental schools in California that received funding to conduct Pipeline programs from The California Endowment and the University of California, San Francisco, which received funding from both foundations; and 3) non-Pipeline schools, the remaining thirty-seven U.S. dental schools (out of a total fifty-two accredited schools included in the study) that were not part of the Pipeline program. References to "Pipeline schools" in general include all fourteen dental schools that conducted programs.
The literature on recruitment that guided our efforts is discussed in Chapter 31 of this report, and the general models and methods of the evaluation are described in Chapter 4.2 We will limit our discussion of methods in this chapter to those specifically related to the recruitment analyses not previously considered. This analysis is organized around a series of questions.
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1. What factors are associated with URM students’ choice of dentistry as a career? |
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). While the frequency with which different strategies are mentioned does not necessarily indicate their relative effectiveness, it does suggest those most salient to stakeholders concerned about URM enrollment.
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To address the general question of which factors are associated with students’ (especially URM students) selection of dentistry as a career, we examined the American Dental Education Association (ADEA) survey questions of graduating seniors in 2007 regarding their reasons for choosing dentistry. The list of possible reasons the students rated is given in Figure 6.1.1. The students were instructed to give a score from 1 (low) through 5 (high) regarding the importance of each of the listed reasons. Figure 6.1.1 shows the percentage of students who rated each reason high (scores of 4 or 5) in importance for choosing dentistry.
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): 1) school—mainly to do with short pipeline recruitment strategies that might be used or influenced by dental schools (six items); 2) service—choice based on desire to serve the general population or a particular subgroup (three items); 3) socioeconomic—choice made because of good job and opportunities for personal gain (three items); 4) models—encouraged to choose dentistry by personal involvement with a dentist or nondentist relative or friend (three items); and 5) knowledge—students liked the perceived characteristics of dental practice (four items). The items that the largest percentage of students rated as of high importance were control of time for work (89 percent), service to others (85 percent), opportunity for self-employment (84 percent), and high income potential (82 percent). The school reasons were least often reported as important, with opportunity to participate in a pre- or postbaccalaureate program the item mentioned most often among these reasons (19 percent).
We created scales for each of the sets of reasons, summing the students’ score for a given set of reasons and dividing by the number of items in that reason set in order to create a scale score. For example, the school category has six items, so we added the scores for those items for each student and divided by six to get the students’ school scale score. All of the individual scale scores vary from 1 (low importance) through 5 (high importance) as do the average scores for all students for a particular scale. Table 6.1.2 provides the average scale scores for all students and according to whether or not they were URM and attended a Pipeline school.
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shows that for all students the knowledge reasons were highest in importance for selecting dentistry (4.18), followed by the socio-economic (3.57), service (3.46), models (2.97), and school (1.75) reasons. This reveals that other life experiences are more influential in career choice of dentistry than the recruiting strategies in which schools might participate. Still, some students did find these strategies important in their career choice, and we examined whether the school scale is particularly important for URM students.
Table 6.1.2 shows that the URM students judged the school reasons as significantly more important in their career choice (1.97) than the non-URM students did (1.72). Thus, among the school scale reasons (not reported in Table 6.1.2), 30 percent of the URM students rated the opportunity to participate in a pre- or postbaccalaureate dental program as an important factor in their career decision compared to 17 percent of the non-URM students, and 16 percent of the URM students reported specific recruitment by a dental school as important compared to 7 percent of the non-URM students. Table 6.1.2 also shows that URM students rated service as more important (4.10) than did non-URM students (3.38). These results suggest that proactive recruiting by schools and emphasizing the opportunities to provide service through dentistry might be especially strong factors for URM students in selecting dentistry. Lastly, this table also shows that models were rated as significantly more important by non-URM students (3.00) than for URM students (2.77), suggesting that role models in dentistry are more accessible to non-URM students than URM students.
We wanted to see if students in the Pipeline schools might be more likely than students in non-Pipeline schools to perceive school factors and service as more important in their choice of dentistry. Table 6.1.2, however, shows no significant differences in either the school scale (1.78 for Pipeline vs. 1.74 for non-Pipeline) or the service scale (3.55 for Pipeline vs. 3.43 for non-Pipeline).
We also wondered whether URM students in Pipeline schools might stress school and service factors more than URM students in non-Pipeline schools. Table 6.1.2 shows somewhat higher scores for the Pipeline URM students on these scales (2.07 vs. 1.90 for school and 4.16 vs. 4.05 for service), but only school was significant at the p<.05 level.
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2. What changes were made in short and long pipeline recruitment during the Pipeline program? |
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Dental school recruitment relationships with two-year community colleges at baseline were unusual. However, six dental schools established relationships with community colleges from 2005 to 2007. At baseline, all fourteen Pipeline schools had relationships with four-year colleges. There was an increase in other short pipeline activities during the project period. These included engagement with a pre-health advisor (eleven schools), mentoring (eleven), a postbaccalaureate program (ten), preden-tal clubs (ten), summer enrichment programs (nine), prematriculation programs (eight), and summer research activities (eight).
Table 6.1.3 shows that the total number of students involved in short pipeline programs in the Pipeline schools increased markedly from 496 in 2003 to 2,466 in 2007. The numbers increased for almost all of the short pipeline programs, with greatest student involvement in 2007 for predental clubs (1,345), summer enrichment programs (396), and special mentoring programs (311).
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An examination of long pipeline programs during the course of the Pipeline program demonstrated that enrollment and participation were variable from year to year at all institutions. During the project period, eleven of the fourteen schools had a science enrichment program. Ten of the fourteen schools had K–12 partnerships. Four of the fourteen did not have programs in place during the project period from 2003 to 2007, and two of the fourteen had no long pipeline programs at all. There was variability in program operations in years and numbers of participants served. One school, for example, had a summer high school program, but most did not. Long pipeline programs are controversial because the outcomes are difficult to track, and the activities are expensive and distant from the payoff of enrollment in dental school.
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3. What do faculty members, administrators, and students see as recruitment challenges and successes in the Pipeline program? |
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Table 6.1.4 rank-orders the challenges most frequently mentioned during the interviews. The most commonly cited challenge in URM recruitment was related to the financial concerns of students. According to these interviewees, the availability of scholarships and financial aid packages and the rising tuition fees of dental schools are major factors affecting recruitment. Stakeholders at private schools, such as Boston University, Loma Linda University, Meharry Medical College, and the University of Southern California (USC), agreed that the cost of education, particularly at private institutions, is a barrier to enrolling students. Although these schools frequently offered additional scholarships and financial aid to applicants, students continually opted for state schools. Moreover, schools located in cities with higher costs of living mentioned that they are frequently passed up for schools in more affordable areas. As one interviewee at a California dental school said, "We are a very expensive private school, and oftentimes, despite your best recruitment efforts, it’s hard for students to see beyond the real consequence of going into debt. That’s the problem that we live with always, and particularly in California, where there are two state schools. So when you do a comparison cost, the reality sets in for students. And I think it’s particularly so with underrepresented minority students."
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Another challenge frequently mentioned by the schools was the lack of staff and resources available to support all the possible recruitment programs and activities (Table 6.1.4). One interviewee said, "One of our weaknesses is just time constraints and staff constraints. We would love to be able to provide much more personal interaction, but we just can’t meet with everyone all the time."
To overcome the lack of in-house personnel, schools such as Howard University and Meharry utilized their alumni sources for recruitment and mentoring programs. Assistance from local chapters of dental societies such as the National Dental Association and Hispanic Dental Association further helped to ease concerns regarding staff shortages. "Our strengths lie with our alumni support," said one interviewee. "Our alumni were willing, in their own cities, to serve as mentors to predental organizations or groups to help expose young people to dentistry who may have never thought of a dental career."
One of the strengths commonly noted in the recruitment of URM students was the commitment of the faculty and administrators. Supportive faculty members helped compensate for deficiencies in the availability of recruitment staff. Members of the Admissions Committee observed the appeal to applicants of one-on-one attention from a faculty member, which facilitated their early connections to the school. Thus, faculty members were often asked to follow-up with applicants with the same areas of interest. One interviewee remarked, "I think that there is a cadre of faculty and administrators here who are interested in recruiting and retaining students to develop personal relationships and who do care."
The supportiveness of the faculty and administrators is confirmed in data collected in a survey of Pipeline schools’ faculty members by the National Evaluation Team (NET) in 2006. Findings indicated that 69 percent of responding faculty members agreed with the statement that the faculty of their respective schools was "positively/very positively" supportive of URM/LI programs. An even larger percentage of faculty respondents (83 percent) indicated that the administration of their school was positive/very positive regarding URM/LI programs.
In the NET interviews, school representatives frequently noted the shortage of URM applicants who qualified for admission, referring to the rising bar in Dental Admission Test (DAT) scores and grade point averages (GPAs). An administrator from the University of California, Los Angeles (UCLA) said, "We’re in an environment which makes recruitment more difficult. We had a 30 percent increase in our applications, and the bar is constantly going higher and higher and higher. So the world is a more competitive world for underrepresented and disadvantaged students." Moreover, there were frequent comments among faculty and administrators that unless the URM applicant pool somehow expands, a continued increase in URM applicants will be difficult to sustain in the future.
Boston University and the University of the Pacific interviewees commented on the added difficulty of attracting students, given the options of other schools in close proximity. On the other hand, considerable distance from students’ hometowns was a barrier for some schools. The added costs associated with having to pay residency tuition and moving to a new city were known deterrents for attracting out-of-state applicants. Furthermore, considerable geographic distance from feeder schools was cited as problematic by a few schools. Therefore, some schools attempted to get an edge on the competition by focusing on regional instead of national recruitment. "Well, I think one of our greatest challenges is the geographic locations of a lot of our feeder schools," said an interviewee. "It seems to be without any true backing of statistics that the groups want to stay in their immediate familial environment. And they have strong encouragement from family to stay close. That is a difficult challenge to overcome."
Another commonly cited challenge was the lack of diversity in the faculty and/or student body (see Table 6.1.4). Some faculty members and administrators felt that there was not a large enough pool of role models for URM students at their schools and that their current URM student population was too small to act as a critical mass for attracting increasing numbers of URM students.
Other challenges frequently mentioned related to project funding, inadequate utilization of feeder schools, and competition with the medical profession. One school in particular was concerned with losing an important member of its Admissions Committee since the position was tied to Pipeline funding. Some schools expressed relief that they were receiving additional funding from Pipeline II (a second phase of the Pipeline program, described in the Afterword of this report3), which will help to maintain their recruitment programs. Funding was often brought up in the context of staff support and resources. Related to staffing, faculty members and administrators expressed a need for more collaboration and partnership with feeder schools to expand recruitment, which would not necessitate drawing on in-house staff. Further, two schools commented that their universities’ medical schools continued to be a bigger draw for health science majors compared to dental school, particularly for URM students. As one said, "The problem is that many of the low-income students who do go on aren’t choosing dentistry. They don’t receive dental services on a regular basis. So dentistry is not on their radar."
Students’ Perspectives
First- and fourth-year students were asked during the final site visit, "How did you select this college to attend?" Their responses provided some insight into successful recruiting activities, as well as potential challenges in recruiting URM students from the student point of view. Table 6.1.5 shows the most frequently cited reasons for choosing a particular school to attend.
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Furthermore, students reaffirmed that schools actively competed for them by way of scholarship offers. Scholarships were a means of competition among the schools. Students recalled that schools would often propose a bigger financial package after learning about another school’s offer.
Some first- and fourth-year students mentioned other factors affecting their decisions, including a support system for URM students, pre-enrollment programs, lower tuition at a public school, and the size of the school. Additionally, our interviews with some URM students once again confirmed the statements of faculty and administrators and prior research findings with regard to the critical mass issue. For instance, a recent study that we conducted6 found that the presence of other minority students was particularly important in attracting African American students, but not as much for Hispanics and American Indians. Findings from the Pipeline evaluation revealed the same pattern: African American students often pointed out that schools with minority faculty and a diverse student body were important in helping them make their ultimate decision to enroll. A critical mass of URM students was an indication for many students that they would have greater support throughout their educational training. "Just what I heard about the school, the family support, the diversity" were factors cited by one URM student. "I just felt like it would be probably the best place for me to get into dental school and get out, with the support I need, being that I’m a first-generation dentist and I really didn’t have any idea what all I was to do or have a big support system outside my family as far as struggling in going to dental school."
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4. How has the Pipeline program affected trends in URM applicants and enrollees? |
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Figure 6.1.2 shows a steady increase in the number of URM applicants to the Pipeline schools over the course of the program: from 1,831 in 2002–03 to 3,249 in 2006–07, an increase of 77 percent. The actual number of URM enrollees also increased but more modestly over this period: from 193 in 2002–03 to a maximum of 257 in 2005–06—a 33 percent increase—before dropping off to 245 in 2006–07—still a 27 percent increase from 2002–03. Among the Pipeline schools, the National Pipeline schools increased URM applicants by 77 percent and enrollees by 15 percent between 2002–03 and 2006–07. The California Pipeline schools increased URM applicants by 79 percent and enrollees by 80 percent over the course of the program.
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Figure 6.1.3 shows that applicants and enrollees from each of the underrepresented minority groups increased at Pipeline schools from 2002–03 to 2006–07. African American applicants increased from 862 to 1,609 (an 87 percent increase) and enrollees increased from 136 to 149 (a 10 percent increase). For Hispanics, applicants increased from 889 to 1,518 (a 71 percent increase) and enrollees increased from 49 to 87 (a 78 percent increase). American Indian applicants increased from 80 to 122 (a 53 percent increase), while enrollees increased from 8 to 9. Excluding Howard and Meharry, the increases were as follows: African Americans, a large 208 percent for applicants and 40 percent for enrollees; Hispanics, 63 percent for applicants and 72 percent for enrollees; and American Indians, 61 percent for applicants and 13 percent for enrollees.
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indicates what proportion of first-year enrollees to all Pipeline schools were URM students and how that proportion increased over the course of the program. URM students made up 14.9 percent of the total entering class in 2002–03; that increased to 19.3 percent in 2005–06 and 18.4 percent in 2006–07. The proportion of the total entering class who were African American and American Indian students increased slightly from 2002–03 to 2006–07: from 10.5 percent to 11.2 percent for the former and from .6 percent to .7 percent for the latter. The proportional increase for Hispanics was much greater: from 3.8 percent to 6.5 percent.
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Impact of Program on URM Recruitment
The trends reported above showed that, over the course of the Pipeline program, the numbers of URM students recruited by the Pipeline schools increased. For the purposes of the Pipeline evaluation, we explored the extent to which the schools’ participation in the Pipeline program influenced the increases in URM enrollment. We can do this by comparing the percent URM enrollment in Pipeline schools to the percent URM enrollment in non-Pipeline schools and how these enrollment proportions changed over the course of the program. The sample analyzed here includes all of the senior dental students responding to the ADEA surveys in 2003 (n=3,697) and 2007 (n=3,841). The impact analysis approach used to explore how school participation in the Pipeline program influenced the outcome in this study is described in the introduction chapter of the cross-site comparisons.7 The analytical framework is shown in Figure 6.1.5. The variable appendix provides definitions and distributions for variables listed in the framework.8 Pipeline status is the key independent variable (whether or not the student was enrolled in a Pipeline school), and the three outcome measures are whether or not the student was 1) URM, 2) Hispanic, or 3) African American. Figure 6.1.5 also shows other variables included in the multivariable analyses, such as community characteristics and dental school characteristics that might influence the URM status of the student. Including these characteristics as control variables helps us to isolate the impact of the Pipeline program and also helps us to understand what other factors influence the odds that a student in a dental school will be a URM.
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portrays URM enrollment in California Pipeline, National Pipeline, and all Pipeline schools combined compared to non-Pipeline schools and how those enrollments changed from 2002–03 to 2006–07. In addition, it shows the independent effects of all the other independent variables included in the model. When odds ratios are not shown for these other independent variables, that indicates that the variable was excluded in preliminary analyses because it was not significantly related to the outcome variables. Because change in enrollment of URM students in minority dental schools might differ from other dental schools, we also conducted the analysis shown in Table 6.1.6 excluding Howard and Meharry from the National Pipeline schools and the University of Puerto Rico from the non-Pipeline schools (see Appendix 29). Any results that varied significantly from the results shown in Table 6.1.6 will be reported in the discussion.
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shows the odds that an enrolled student in 2002–03 was a URM were different in Pipeline schools compared to non-Pipeline schools. In general, the odds ratios are not significantly different from 1, except that the odds of enrollment of African American students in the Pipeline schools in that year were significantly less than in non-Pipeline schools. The findings were similar excluding the minority institutions.9 The second row shows the odds of change in enrollment for non-Pipeline schools between 2002–03 and 2006–07. None of these odds ratios were significantly different from 1, suggesting no change in URM enrollment in the non-Pipeline schools. Again, the findings were similar excluding the minority institutions.9
The third row shows the change in URM enrollment from 2002–03 to 2006–07 for Pipeline compared to non-Pipeline schools. This row shows significant differences for total URM and African American enrollment. All Pipeline schools showed significantly greater increases in the odds of URM and African American enrollment between 2002–03 and 2006–07 than did the non-Pipeline schools. The changes were not significantly different between Pipeline and non-Pipeline schools for Hispanic enrollees. However, when we exclude Puerto Rico from the non-Pipeline schools, the California Pipeline schools showed a significantly greater increase in the odds of Hispanic enrollment between 2002–03 and 2006–07 than did the non-Pipeline schools.9 Conversely, when we excluded Howard and Meharry from the National Pipeline schools, the odds of increases in URM enrollment were no longer significantly greater for the National Pipeline or all Pipeline schools compared to the non-Pipeline schools.
The fourth row of Table 6.1.6 shows the odds of change in URM enrollment for Pipeline schools between 2002–03 and 2006–07. For California Pipeline, National Pipeline, and all Pipeline schools combined, the significant odds ratios show that percentages of all URM and African American enrollment increases were significantly higher in 2006–07 than in 2002–03. None of these odds ratios were significant for Hispanic students. However, when we excluded the minority schools from the analysis, the odds ratio in the California Pipeline schools indicated that the increase in enrollment of Hispanic students between 2002–03 and 2006–07 was significantly greater in the California Pipeline schools than in the non-Pipeline schools.9 In contrast, the odds ratios for total URM enrollment increase for National Pipeline schools and all Pipeline schools combined were no longer significant.
The fifth row shows whether the odds of URM enrollment in 2007 were greater in Pipeline than in non-Pipeline schools. None of the odds ratios in this row were significant either in Table 6.1.6 or in the analyses excluding the minority dental schools.
Other variables systematically associated with odds that a student would be a URM in Table 6.1.6 and in the analyses excluding the minority schools9 included two contextual variables: 1) adult Medicaid benefits in the state where the student’s dental school was located (while we had expected schools in states offering more generous adult Medicaid benefits for dental care would show greater increases in URM enrollment, we actually found the schools in states not offering adult dental benefits more likely to increase URM enrollment); and 2) percentage of URMs, Hispanics, or African Americans in the county where the student’s dental school was located. These findings reveal that ethnic and racial diversity in the county surrounding the dental school does have a positive effect in the recruitment of URM students: as expected, dental schools in counties with a higher proportion of URMs were more likely to increase their URM enrollment.
Two dental school characteristics were also significantly associated with the odds that a student would be a URM: 1) private dental schools increased their URM enrollments more than public schools, contrary to our original expectations; and 2) the percentage of URM clinical faculty in the dental school was quite strongly associated with the odds that a student would be URM, Hispanic, and African American in the analyses for all Pipeline schools.
These results suggest that the Pipeline program did have some significant influences on increases in URM enrollments based on comparisons with the non-Pipeline schools, after taking into account other contextual and dental school characteristics that might influence URM enrollment. Excluding the minority schools from our analyses suggested increased Pipeline effects on Hispanic enrollment in the California Pipeline schools and reduced Pipeline effects on total URM enrollment. However, clearly both analyses (for all dental schools and those excluding the minority schools) imply Pipeline influence on dental schools’ enrollments of URM students, doing our best to adjust for a relatively weak evaluation design (no random allocation of the Pipeline program to dental schools).
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5. What contributes to the retention of URM students? |
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At the final site visit, students were asked: "Please describe any programs, activities, or relationships that have helped you to stay in and succeed in dental school." The students identified a number of programs, activities, and relationships as having a positive impact on their experience and success in dental school. Table 6.1.7a shows the top five factors they named. The numbers in parentheses show the total times a reason was given as a crucial factor in dental school retention. Among these factors, both first- and fourth-year students rated faculty members and classmates as their top two positive influences. In addition, first-year students cited student mentors, postbaccalaureate programs, and the general school environment, while the fourth-year students mentioned family and friends, student organizations, and self-motivation as crucial to their dental school success.
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shows the top three facilitators and barriers mentioned by first- and fourth-year students to solving difficulties with courses. Both groups of students considered faculty members their biggest supporters. On the other hand, we heard a number of negative comments regarding the unavailability and unwillingness of faculty members in helping students outside the classroom. General school environment received mixed results as some students found it supportive while others considered it rather unfriendly and intimidating. Some first-year students attributed their success in school to self-motivation yet commented negatively on the class schedule, while fourth-year students found both positive and negative aspects in special tutoring sessions. In sum, the two primary factors that were said to have helped both first-year and fourth-year dental students stay and succeed in dental schools were relationships with faculty members and relationships with classmates. Other factors such as general school environment, special tutoring sessions, self-image, family members, postbaccalaureate programs, student organizations, and student mentors were all perceived to have a positive impact. On the other hand, a minority of students suggested that the apathy of some faculty members and the unfriendly general school environment hindered their success and achievement. The heavy courseload and sequence in which courses were taught were perceived by some as barriers to student performance. Additionally, the difficulties lower-performing students faced in getting help from tutors were perceived as barriers to student performance.
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6. How do low-income students differ from URM students? |
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shows this not to be the case. Of all the students in the 2007 ADEA senior survey whose parents had reported or imputed yearly income of $50,000 or less (our proxy definition of an LI student), only 17 percent were URM students. Conversely, of all URM students in this survey, only 32 percent were low-income. Consequently, we wished to examine how reasons for going into dentistry and their practice intentions might differ according to income level and minority status, and whether there seemed to be any difference in the change in recruiting LI students between 2002–03 when the program started and 2006–07 when it concluded.
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shows the percentage of students giving various reasons as important for going into dentistry according to their income level and ethnicity. The reasons are divided according to scales developed in this study as school reasons, service reasons, socioeconomic reasons, models of dentistry reasons, and knowledge of dentistry reasons. The average scale scores according to income and URM status are shown in Table 6.1.10. We tested for significant differences across all four income and URM status groups using a bonferroni multiple means test. Groups with the same letter are significantly different from each other at the p<0.05 significance level.
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shows that school reasons are more important for URM than non-URM students regardless of income. For example, we see from Table 6.1.9 that opportunity to participate in a pre- or postbaccalaureate dental career program was mentioned as important by 32 percent and 28 percent of the high- and low-income URM students, respectively, compared to 16 percent and 18 percent of the high- and low-income non-URM students. Further, 25 percent of both income groups of URM students mentioned a visit to a dental school as important compared to 17 percent and 15 percent of the non-URM income groups.
Service reasons are shown in Table 6.1.10 to be much more important for the URM students of both income groups compared to the non-URMs. For example, from Table 6.1.9 we see that "opportunity to serve my own race or ethnic group" was selected as important by 67 percent and 69 percent of the high- and low-income URM students, respectively, compared to 20 percent and 29 percent of the high- and low-income non-URMs.
Table 6.1.10 shows that socioeconomic reasons were less important to low-income URM students than to high-income URM students and both income groups of non-URMs. Thus, we see in Table 6.1.9 that community status and prestige were selected as important by 52 percent of the low-income URM students compared to 60 percent of the high-income URMs and 55 percent and 57 percent of the high- and low-non-URMs, respectively.
Table 6.1.10 also shows that models of dentistry were less important to low-income URM students than the other three groups. Thus, in Table 6.1.9 we see that mentioning that a family member, relative, or friend who was a dentist was given as an important reason by 36 percent of the low-income URM students compared to 48 percent of the high-income URM students and 54 percent and 43 percent of the high- and low-income non-URMs respectively. These findings reflect the lower probability that these low-income students had dentists in the family.
Finally, Table 6.1.10 shows that there were no significant differences in the importance of knowledge and appreciation of dentistry according to minority status or income level. Knowledge of dentistry was very important to each group. One item in the knowledge of dentistry scale did show a significant difference according to URM status but not income. High- and low-income URM students were more likely to report "variety of career options" was important in their choice (70 percent) than non-URM students of either income group (about 60 percent) (Table 6.1.9).
Table 6.1.11 shows important differences in students’ practice intentions after graduation according to income level and ethnic status. About one-half of the URM students of both low and high income expect to serve 25 percent or more minorities when entering practice compared to 28 percent of the non-URM low-income students and 17 percent of the non-URM high-income students. Similarly, higher proportions of both the low- and high-income URM students intended to serve 11 percent or more disabled patients when entering practice and having community service as their primary activity after graduation. However, planning to enter general practice and expecting to serve in an area that has 25 percent or more rural patients did not differ significantly according to URM status or income.
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7. Did the TCE program increase recruitment collaboration among California schools? |
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Regional Collaboration Activities
In August 2003, the TCE Pipeline program brought together representatives of the five California dental schools to establish a Recruitment Committee, and monthly meetings were scheduled, with Dr. Charles Alexander of the University of California, San Francisco (UCSF) serving as chair. By May 2004, the committee had developed a regional plan and had established goals to double the number of URM/LI students accepted to California dental schools and to establish sustainable recruitment programs that would build on the collaboration among the five schools. Also participating in the committee meetings were Dr. David Brunson from ADEA and Dr. Howard Bailit and Ms. Kim D’Abreu from the National Program Office.
A plan was developed to target undergraduate schools and have each dental school take responsibility for recruiting URM/LI students at assigned California State Universities for all five schools. The group also agreed to develop, test, and distribute recruitment materials, such as brochures, videotapes, and a website to serve all five schools. They planned and held two annual meetings of pre-health college advisors—one for Northern and one for Southern California schools—with all dental schools participating in both meetings. They made plans to work with their respective medical schools. Recognizing the success of the UCSF postbaccalaureate program, the group agreed to develop a postbaccalaureate program in Southern California. They also planned to develop and implement a summer enrichment program for promising URM/LI undergraduates.
The five dental schools shared the cost of the program components in which all the schools participated: development of recruitment materials, annual meetings, and enrichment programs. They developed an annual recruitment plan and selected a chair to serve for two years and rotate among the regions. The Recruitment Committee shared program responsibilities such as staff time, supplies, and space.
A major accomplishment was the development of a recruitment manual outlining recruitment practices that could be replicated in other states or regions. The elements of a statewide manual were outlined in December 2004; the completed manual was reviewed by outside reviewers. The manual outlined the regional approach to student recruitment and assisted the schools in implementing the program.
Summer enrichment programs were intensive eight-week activities. UCSF School of Dentistry took the lead in a summer enrichment program for all the UCSF graduate and professional schools, including the School of Medicine, the Graduate Division, the School of Pharmacy, and the School of Nursing. This represented a long pipeline effort with high school students, which provided good experiences for all schools, including clinical experiences and an opportunity for minority students to bond and belong. Schools reported that there were good cross-learning and networking experiences.
An eleven-month regional postbaccalaureate program to provide academic and clinical enrichment to disadvantaged students and students from underserved communities was established to assist students in becoming more competitive for admission to dental school. The Southern California Regional Postbaccalaureate Program began in the summer of 2004. Loma Linda, USC, and UCLA planned to have three students each in the program. The program included an intensive six-week summer session for all students at UCLA. Students were enrolled in the UCLA School of Medicine PREP enrichment program. The postbac students then continued with nine months of coursework at each of the schools. Joint seminars and academic sessions were planned for the year. In Northern California, UCSF reported that the postbac program had sixty-nine of its seventy graduates enrolled in dental schools.
The mentoring program offered an opportunity to showcase applicants and create networking for students at annual dinners and luncheons for entering students. The Recruitment Committee established southern and northern collaboration groups. The committee established relationships with minority professional organizations such as the National Dental Association and Hispanic Dental Association, made presentations to their members, and recruited at events where materials were distributed.
The five dental schools agreed to work with the California State Universities to identify recruitment opportunities for URM/LI students at feeder schools with high proportions of URM students. Feeder schools were identified that would be the focus of increased efforts. Each dental school selected four feeder schools in its area as partners. Dental schools met as frequently as monthly with pre-health advisors at the feeder institutions to strengthen relationships. The Recruitment Committee used the Western Regional meeting of College Preprofessional Health Advisors as an opportunity to increase dental awareness.
Results of the Regional Collaboration
Regional efforts promoted sharing and support among schools for the development of URM/LI applicant pools. Changes in admissions policies, procedures, and committee composition improved the climate for URM/LI recruitment and ultimately increased applicants and students. Short pipeline efforts were effective for increasing the number of competitive URM/LI applicants. The faculty was a major stakeholder, and its perceptions played a role. Faculty members perceived having students from diverse backgrounds as improving the educational experience for all dental students and agreed that recruitment of URM/LI students should continue.
"Instead of having a competition, there is collaboration," stated the director of recruitment at the University of the Pacific dental school. Among its strong points, this administrator mentioned "the predental advising that all five dental schools get together [to deliver] twice a year, one in Northern California and one in Southern California. It shows the advisors that the state of California’s dental schools are working together with them. I just think it’s been a tremendous asset to have all five of us present talking to the advisors and seeing the collaboration."
When the program started, the dental schools had different levels of expectation. The Pipeline program provided leadership and sharing opportunities that led to successful regional efforts. Over time, the California schools agreed on approaches that have worked for both the public and private dental schools in the state.
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Increased emphasis in the Pipeline schools on recruitment programs seen as relatively more important by URM students can be noted by the growth in short pipeline programs. These programs in Pipeline schools that prepare undergraduate and graduate students for dental school involved 496 students in 2003 and 2,466 in 2007—an increase of almost 400 percent. All of this increase cannot be attributed to the influence of the Pipeline program, but it certainly shows schools moving strongly in directions espoused by the program.
Despite increased recruiting efforts, formidable challenges remain in recruiting URM students in Pipeline schools. Most frequently mentioned by Pipeline school administrators and faculty were financial concerns of students, inadequate recruitment resources and support staff, competition from other schools for the same pool of qualified URM students, and an insufficient critical mass of current URM students and faculty members. Responses to these challenges included redoubling efforts to secure financial aid for URM students, developing early relationships between applicants and faculty members, using alumni for recruitment programs, and increasing general support of administration and faculty for URM recruitment. Dental students reported their primary reasons for selecting a school were its convenient and attractive location, reputation for excellence, institutional friendliness, lower cost, and financial aid.
Central to the evaluation of the Pipeline program is the URM enrollment increase in the Pipeline schools over the course of the program (from 2003 to 2007) and the extent to which this increase might be associated with the Pipeline program. Our data do show considerable increases in the number of URM applicants (from 1,831 to 3,249) and enrollees (from 193 to 245). Over this period, URM students as a percentage of total enrollment grew from 14.9 percent to 18.4 percent. Furthermore, the multivariable analysis comparing the change in URM enrollment in Pipeline and non-Pipeline schools suggests that the Pipeline program did have some significant influences on URM enrollments after taking into account other contextual and dental school characteristics that might influence enrollment.
To round out the story of URM recruitment, we wanted to know about URM student retention, the extent to which an emphasis on URM recruitment would address the issue of recruiting more low-income students, and whether Pipeline schools collaborated in URM recruitment. We found that most schools did not consider URM retention a special problem although it was a concern to minority institutions. The factors that both first- and fourth-year students mentioned as central to their retentions were supportive relationships with faculty and classmates. The emphasis that the Pipeline program placed on recruiting URMs is not adequate to cover low-income students. Of the low-income students, only 17 percent were URM. However, in considering why students go into dentistry, we found that both service and school reasons were more important to URM than non-URM students regardless of income. Further, socioeconomic and models of dentistry reasons were less important to low-income URM students than to low-income non-URM students and both higher-income groups. These data as well as the practice intention data suggest that the low-income non-URM students are much more similar to the higher-income groups (especially the non-URM higher-income group) than they are like the URM low-income group, and recruitment efforts should reflect these differences.
At the beginning of the Pipeline program, the California Pipeline schools were urged to cooperate in regional California recruitment. The Pipeline program provided leadership and sharing opportunities that led to successful cooperative efforts to recruit URM students and established a model of practice that has implications for the future.
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