Applying a systems oriented ethical decision making framework to mitigating social and structural determinants of health.

Objectives: Clinical ethical decision-making models are largely geared toward individual clinician choices and individual patient outcomes, not necessarily accounting for larger systemic issues that affect optimal patient outcomes. The purpose of this paper is to provide an ethical decision-making model, drawing upon systems orientation and ethical theory, specifically incorporating and aiding in the mitigation of social and structural determinants of health. Methods: This paper presents a systems-oriented ethical decision-making framework derived from the analysis and critique of the Four-Box Method for Ethical Decision-Making by Jonsen, Siegler, and Winslade. Drawing upon both deontological and utilitarian ethical theory, the developed framework will assist providers, organizations, and health system leaders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations, who are largely impacted by social and structural determinants of health. Results: The needs of underserved patients are inextricably linked to various social and structural determinants of health that, if left unaddressed, result in even poorer health outcomes, exacerbating existing health disparities. A systems-oriented ethical decision-making framework, centered on obligation, duty, and a utilitarian view of the optimal good, will aid providers, organizations, health system leaders, and community stakeholders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations. Conclusion: Socioeconomic and political contexts have a significant impact on the way society is organized, how people are positioned in society, and how they will fare in terms of their health. Healthcare providers, including dentists, are largely unaware of and insensitive to the social issues that underlie the biological or psychological concerns that patients from socially disadvantaged backgrounds face. A systems-oriented ethical decision-making model will aid in mitigating social and structural determinants of health and the dental profession's obligations to the underserved.

Men of color in the health professions: Proceedings from the 2022 ADEA Men of Color in the Health Professions Summit.

The purpose of the American Dental Education Association (ADEA) Men of Color in the Health Professions Summit, held in August 2022 at ADEA's headquarters in Washington, DC, was to gather key thought leaders across a myriad of health professions and healthcare organizations and schools to cultivate intentional cross-disciplinary efforts in championing the need to address the low number of men of color entering not only dental, but also medicine, pharmacy, and health-related research careers. A pivotal follow-up step from the inaugural ADEA President's Symposium on Men of Color in the Health Professions at the March 2022 ADEA Annual Session & Exhibition in Philadelphia, the summit brought together academic health professions leaders, government agencies, health professions associations, and other key stakeholders to develop an action plan to support men of color entering the health professions. Moving the needle forward and increasing opportunities for underrepresented men of color in the health professions requires all academic health professions to work together. Highlights of the Summit included a keynote presentation by David Satcher, MD, PhD, the 16th Surgeon General of the United States; workgroup consensus statement development; health career pathways program presentations; strategic forecasting regarding challenges and opportunities in developing a coalition of health professions organizations to support men of color in the health professions; and frameworks for exploring coalition building.

Centring anti-oppressive justice: Re-envisioning dentistry's social contract.

OBJECTIVES: We re-envision dentistry's social contract and elaborate on the idea that it is not neutral and free from such things as racism and white supremacy and can act as a tool of oppression. METHODS: We critique social contract theory through examination of classical and contemporary contract theorists. More specifically, our analysis draws from the work of Charles W. Mills, a philosopher of race and liberalism, as well as the theoretical and praxis framework of intersectionality. RESULTS: Social contract theory supports hierarchies and inequities that may be used to sustain unfair and unjust differences in oral health between social groups. When dentistry's social contract becomes a tool of oppression, its practice does not promote health equity but reinforces damaging social norms. CONCLUSION: Dentistry must embrace an anti-oppression framing of equity and elevate the principle of justice to one of liberation and not just fairness. In doing so, the profession can better understand itself, act more equitably and empower practitioners to advocate for justice in health and healthcare in its fullest sense. Anti-oppressive justice supports health not as merely an obligation but as a human duty.

Professionalism and professional identity formation in dental students: Revisiting the professional role orientation inventory (PROI).

OBJECTIVE: Professionalism is a hallmark of health professions education. Professional identity formation is a growing field of exploration in medical education, and the dental literature is sparse on just how professional identity formation is developed and assessed within dental education. METHODS: The validated professional role orientation inventory (PROI) was administered to 2nd year dental students during a spring semester ethics course. The PROI includes four 10-item scales representing four attitudinal factors: Authority, Responsibility, Agency, and Autonomy. RESULTS: When compared to a historical sample of dental students in the early 1990s, dental students today scored significantly higher on Responsibility (p = 0.0309) and lower on the Agency factor (p = 0.0001). Authority scores in the current sample of dental students were significantly associated with age and race, with an increase in age associated with a decrease in Authority (p = 0.0504) and Caucasian respondents demonstrating significantly higher scores than Asian or Other races. Debt was associated with differences in Autonomy (p = 0.0683) and Agency (p = 0.0106), with those in the 100k-300k anticipated debt range demonstrating lower levels of both Autonomy and Agency. Race was marginally associated with Responsibility with those in the Other race category (Hispanic, Black/African American, Other/Multiracial) demonstrating higher levels than Caucasian (p = 0.0513). CONCLUSION: Dental students' scores denote a continued commitment to others yet a feeling of less sense of control as a practicing professional. A redefining of professionalism to include social activism and advancing health equity is required given their altruism and commitment to others, which remains high.

Illuminating light in the darkness: Black/African-American men in dental education and strategies for change.

The purpose of this article is to discuss the challenges surrounding the underrepresentation of Black/African American (BAA) men in dentistry and dental education and present a rationale for anti-racism strategies to address them. Data and insights from the literature are presented to discuss how racism may derail BAA's opportunities to achieve a dental education through stereotyping, social, and academic isolation. Additionally, the authors present commentary and testimonials on the importance of mentorship to guide BAA men into and through dental careers. Additionally, the article describes two examples of successful career pathway programs, and highlights the significance of historically Black colleges and universities to promoting diversity within the dental profession. Anti-racism recommendations for change include more direct attention to how dental school humanistic environments support BAA men, committing human and financial resources for program development, and using data-driven metrics to assess those programs longitudinally. The commitment of dental education to promote oral health equity demands more than appreciation of BAA men's contributions, but a commitment to creating and advancing opportunities that assure their success.

Can academic dentistry become an anti-racist institution?: Addressing racial battle fatigue and building belonging.

Racism, oppression, and marginalization are unfortunate hallmarks that Black individuals face in the United States. While dental schools serve as institutions of both learning and patient care, applying humanistic principles, they are not immune to racism, specifically anti-Black racism. In this paper, the theoretical framework of racial battle fatigue is applied to academic dentistry to consider how it may impact faculty who have experiences with racism and discrimination. The framework of racial battle fatigue allows for a critique of academic dentistry as an institution that may be toxic, neither welcoming Black faculty members nor supporting their professional and career advancement, despite accreditation standards that call on these institutions to be humanistic environments for diversity and inclusion. Black faculty members may face unique challenges in academic dentistry because of racial battle fatigue. The cumulative stress may warrant unique strategies to both recruit and retain them in academic dental institutions. Specifically, pathways may need to be funded to insure that they have support and time allocations for professional development and career promotion. With understanding the effects of racial battle fatigue, dental schools may want to adopt policies and practices that support the professional and personal well-being and success of faculty, especially those faculty members who are Black.

Men of color in the health professions: Proceedings from the 2022 ADEA President's symposium.

The purpose of the American Dental Education Association (ADEA) President's Symposium on men of color in the health professions, hosted at the 2022 ADEA Annual Session and Exhibition, was to draw attention to the need to address the low numbers of men of color not only entering dental education but also across medicine and health-related research careers and to identify strategies for change. Stakeholders in health professions education shared their professional insights and best practices. Highlights of the Symposium included discussions of funding for pathway programs, leveraging data-driven metrics through strategic partnerships, mentorship, and accountability among dental schools, medical schools, and health science research organizations.

Dental faculty well-being amid COVID-19 in fall 2020: A multi-site measure of burnout, loneliness, and resilience.

PURPOSE/OBJECTIVES: This study aimed to understand the impact of the COVID-19 pandemic on dental school faculty's self-reported burnout, loneliness, and resilience. METHODS: A 34-item questionnaire composed of three previously validated scales - adapted Copenhagen Burnout Inventory, the brief resilience scale, and a short loneliness scale - and demographic information was sent by email to dental school faculty in four dental schools across the US during the sixth and seventh months of the COVID-19 pandemic. RESULTS: Two-hundred sixteen (19.63%) of faculty invited to participate completed the survey. On a scale of five, with five indicating extreme burnout and one indicating no burnout, the average personal burnout was 2.7 (SD = 0.83), and work-related burnout (WRB) was 2.8 (SD = 0.83). Personal and WRB decreased with increasing age. WRB was significantly higher among full-time faculty, females, and those living alone. Faculty who lived alone experienced more loneliness than those who lived with others. Resilience was not a statistically significant difference across demographic groups. Regarding the impact of COVID-19 pandemic on their burnout, loneliness, and resilience on a scale ranging from "Never" (scored as 1) to "A great deal" (scored as 5), the average response for burnout was 3.3 (SD = 1.01), loneliness was 2.6 (SD = 1.10), and resilience was 2.8 (SD = 0.99). CONCLUSION(S): While self-reported burnout and resilience scores did not show a significant increase during the pandemic, the rates of burnout and loneliness remain higher than the public. Dental education has real challenges and opportunities to explore individual and organizational interventions to combat burnout and loneliness and enhance resilience among faculty.

A descriptive pilot study of the immediate impacts of COVID-19 on dental and dental hygiene students' readiness and wellness.

BACKGROUND: The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has impacted dental students training across the U.S. academic dental institutions by moving classroom instruction to an online modality, limiting patient care, canceling external rotations, and rescheduling of licensure examinations. OBJECTIVE: The aim of this study was to assess the immediate impacts of COVID-19 on students' readiness to enter clinical practice or residency and its association with well-being (anxiety, perceived stress, coping and social support, and resilience). METHODS: An online REDCap survey was distributed to 407 D1-D4 year dental students and 29 DH3-DH4 year dental hygiene students enrolled at a U.S. dental school. The survey consisted of readiness and wellness measures as well as socio-demographic variables. RESULTS: Overall response rate was 58% (N = 252) ranging from 40% among D4 students to 72% among D1 students. About half (55%) of the respondents were White, a third (34%) Asians and 5% were African Americans. Ninety-two percent were non-Hispanics while 62% were female. Overall mean (SD) anxiety score was 6.5 (5.3) and 26% of respondents reported moderate or severe levels of anxiety. Anxiety score differed significantly by gender with females reporting higher anxiety levels, mean (SD) = 7.3 (5.5) versus 5.2 (4.7) for males; P = 0.002). Furthermore, mean anxiety score differed significantly among the dental school classes, ranging from 5.5 (5.3) among D2 students to 11.8 (6.2) in DH4 students (P = 0.02). CONCLUSION: Academic dental institutions need to be responsive to the heightened anxiety and uncertainly levels of students and provide responsive training and support to mitigate its effects.

An analysis of resilience in dental students using the Resilience Scale for Adults.

OBJECTIVES: Resilience is the ability to bounce back or recover from major life stressors. The aim of this study was to investigate resilience in dental students and how it may or may not vary across demographic characteristics such as gender, socioeconomic status, race/ethnicity, self-reported health, and parental educational level. METHODS: Data were collected from 151 dental students at Virginia Commonwealth University School of Dentistry with an anonymous survey that included the Resilience Scale for Adults (RSA) and various demographic variables. Associations between RSA and variables of interest were assessed using linear models. RESULTS: Dental students demonstrated relatively high levels of resilience. Resilience was significantly associated with gender (with females showing more resilience than males (P = 0.0395)), race (P = 0.0025), overall health (P = 0.0101), and mental health (P < 0.0001). Results from Exploratory Factor Analysis (EFA) supported a 5-factor solution that explained 82.6% of the variability of resilience in the sample of dental students. The 5 factors were nearly identical to the 5 subscales originally described by the RSA demonstrating validity in this population. Overall health ratings were significantly related to resilience, suggesting that perceived resilience in dental students may protect against negative health outcomes. This study can inform internal and external support systems of dental students as well as institutional programmatic development to better support their educational experiences.

Dental education and care for underserved patients: an analysis of students' intentions and alumni behavior.

The U.S. surgeon general's report on oral health stressed the importance of providing dental care to underserved patients. The objectives of this study were to explore a) dental students' intentions and dentists' behavior concerning treating underserved patients, b) their perceptions of their education concerning these patients, and c) the relationship between dental education and their attitudes and behavior. Data were collected from 328 dental students (response rate: 77.5 percent) and 234 alumni (response rate: 43.7 percent). Only 67.4 percent of the students and 38 percent of the alumni indicated that their education had prepared them well to treat patients from different socioeconomic backgrounds; 71.3 percent of students and 55.2 percent of alumni responded that they had been well educated to treat patients from different ethnic/racial groups. The findings showed a positive relationship between the degree of curriculum focus on the importance of treating patients from all aspects of society and students' and alumni intentions to provide inclusive patient care to patients from diverse backgrounds. The more students agreed that their dental education had prepared them well to treat patients from different ethnic backgrounds, the more likely they were to report that they intended to treat these patients (r=.12; p=.033). In a similar manner, the more the alumni agreed that their dental education had prepared them well to treat patients in different communities, the more likely they were to treat patients from different socioeconomic backgrounds (r=.18; p=.009). In conclusion, these findings showed that access to oral health care for underserved patients could potentially be increased if dental students were more overtly educated about the importance of treating patients from all segments of society.