Influence of Community-Based Dental Education on Dental Students’ Preparation and Intent to Treat Underserved Populations

Discussion

We believe that community-based education experiences make important contributions to a student’s professional growth. This study demonstrates how CBDE improves students’ confidence and perceived skill level when treating low-income and underserved patients. Our data also suggest that several weeks spent in CBDE rotations that offer experiences in a variety of community dental health care settings can increase the likelihood that a student will select a community dental clinic as a first career choice.

The student survey in 2009 showed a significant increase in perceived student skill and confidence level when treating low-income and underserved patients after CBDE rotations and that students’ attitudes were positive both before and after the rotations. After spending eight weeks in CBDE rotations, the students felt more prepared to treat low-income and underserved patients after graduation than before these rotations. The survey also revealed that, after the CBDE rotations in 2009, a large portion of the graduates planned to include low-income, Medicaid-eligible patients as part of their future dental practice. Two-thirds of the survey respondents planned to devote at least 10 percent of their future practice to Medicaid-eligible patients. Furthermore, 23 percent of those who planned to devote at least 10 percent of their future practice to Medicaid-eligible patients intended to treat these patients as more than 50 percent of their practice. It is important to note that asking questions about perceived ability before the rotations when students had already completed them introduces a potential bias. The better approach would have been to survey the students both before and after their rotations for the most accurate measure of change.

Our data demonstrate that the number of students who chose a community dental clinic as their first career path increased as the time spent in rotations increased. This increase was most dramatic when students participated in eight weeks of CBDE rotations that included multiple clinic types. Before the CBDE rotations (from 1998 to 2000), only 1.7 percent of students chose to practice in a community dental clinic, but when students spent at least three weeks in CBDE rotations the percentage increased to 6.1 percent. This suggests that any participation in CBDE, even for a few weeks, can increase students’ selection of community dental clinics as their first career path. Finally, when the outreach rotations increased to eight weeks and included multiple clinic types, 11.8 percent of students in 2009 and 16.5 percent in 2010 chose to practice in a community dental clinic. These findings suggest that more weeks in CBDE rotations that include multiple clinic types may increase the number of students who choose community-based clinics as their first career choice. It is important to note that the students who entered a postdoctoral general dentistry program after graduation may also choose to work in a community-based clinic after completing the program, which would increase the percentage of graduates ultimately working in community clinics. A long-term study would produce a more accurate representation of these graduates’ practice locations.

The goal of the community-based dental education program at the University of Michigan School of Dentistry is to enhance students’ educational and clinical experiences as well as promote dental health equity for all populations. The program experience supports patient-centered care that teaches students an ethic of care and civic responsibility. By offering the experience of working with patients at or below 200 percent of the U.S. poverty level with complex medical problems in a variety of health care delivery systems, students become confident in their didactic and clinical skills in treating low-income and underserved populations. When students are given this kind of exposure to the needs and challenges of caring for the underserved, they become prepared to work with these populations in their future practice. However, our endeavors never remain static, and we always try to remember two important points. First, since oral health care is a dynamic profession, nothing remains “as is” for very long. We have to be nimble. Therefore, we try to do our best to adapt to the needs of our partners who are doing their best to respond to the needs of patients in their communities. Our flexibility conveys an important message to our students: that they too will have to be adaptable as practitioners. Second, the number of school-approved community sites is always changing and growing because we are constantly searching for the most effective model. It is important to observe approaches taken by our partners in communities across the state and even at different clinics within the same community. Learning that one size does not fit all helps students become more familiar with the diverse opportunities in dentistry. It is our hope that, through these influential experiences, our young professionals will take an active role in our profession that will ensure that all have access to care.