Why dental schools should engage with dental support organizations.

It is incumbent on dental educators to prepare students for careers in various practice settings and modalities. As the dental practice market continues to evolve away from a predominantly solo private practice model, schools are tasked with training future providers to deliver quality care to diverse patient populations in diverse settings. While no single health delivery model will solve access to care, exposing dental students to various practice environments prepares them to better understand and navigate nontraditional postgraduate practice opportunities. The University of California, Los Angeles (UCLA) School of Dentistry established a community-based clinical education (CBCE) program that has grown to include dental support organizations. By partnering with a more diverse portfolio of practice types, including large corporate entities, the UCLA CBCE program has strengthened its financial accountability while also delivering on the goal of enhancing dental education and improving access to care for vulnerable populations.

Immediate impact of bringing a school to the community with a new community-based clinical education program.

OBJECTIVES: To examine the implementation of a community-based clinical education (CBCE) program at the University of California, Los Angeles School of Dentistry (SOD) and the preliminary outcomes on dental students and affiliated clinics. METHODS: A retrospective review was carried out of SOD CBCE program implementation and program data between March 2018 and June 2019 related to patient encounters, pre- and post-rotation student self-assessments, student exit surveys and surveys administered to faculty within affiliate clinics. RESULTS: In five academic quarters, 133 students delivered care for 7556 patients and completed 12,467 procedures in underserved communities. Students reported increased confidence across 14 areas of self-assessment. The percentage of students reporting future plans of working in public health clinics upon graduation increased from 6% to 19%. Affiliate clinic faculty indicated increased care delivery for underserved patients, appointment availability, and job satisfaction. CONCLUSIONS: The newly implemented UCLA SOD CBCE program preliminarily yielded immediate positive outcomes for SOD students and affiliate community clinics.

Should Attendance Be Required in Lecture Classrooms in Dental Education? Two Viewpoints: Viewpoint 1: Attendance in the Lecture Classroom Should Be Required and Viewpoint 2: Attendance Should Not Be Required in the Lecture Classroom.

This Point/Counterpoint discusses the long-argued debate over whether lecture attendance in dental school at the predoctoral level should be required. Current educational practice relies heavily on the delivery of content in a traditional lecture style. Viewpoint 1 asserts that attendance should be required for many reasons, including the positive impact that direct contact of students with faculty members and with each other has on learning outcomes. In lectures, students can more easily focus on subject matter that is often difficult to understand. A counter viewpoint argues that required attendance is not necessary and that student engagement is more important than physical classroom attendance. This viewpoint notes that recent technologies support active learning strategies that better engage student participation, fostering independent learning that is not supported in the traditional large lecture classroom and argues that dental education requires assimilation of complex concepts and applying them to patient care, which passing a test does not ensure. The two positions agree that attendance does not guarantee learning and that, with the surge of information technologies, it is more important than ever to teach students how to learn. At this time, research does not show conclusively if attendance in any type of setting equals improved learning or ability to apply knowledge.

Psychometric Evaluation of a 13-Point Measure of Students' Overall Competence in Community-Based Dental Education Programs.

Since 2006, the University of Michigan School of Dentistry has used a 13-point measure of overall competence instrument to assess fourth-year dental students' end-rotation performance at community clinics. The aim of this study was to assess the reliability and validity of this instrument used by preceptors to rate students' overall competence during community-based dental education experiences. The measure was analyzed using performance ratings for all fourth-year DDS students in the graduating classes of 2012 and 2013 (combined n=201). The results were that interrater agreement was satisfactory and the measure scored high for internal consistency; also, the measure loaded highly on a single overall competence factor. Ratings on this measure did not correlate with students' final cumulative dental school GPA, but showed a significant positive correlation with their fourth-year fall patient management grades (which signify students' conscientiousness in managing patients and their families in a professional and ethical manner). There were differences in grading systems between the 2012 cohort (which used a pass/fail system) and the 2013 cohort (which used a letter grade system) and the mean ratings they received (higher for the 2013 cohort). Overall, the study found that the 13-point measure demonstrated excellent reliability and validity, suggesting it is useful in determining a student's clinical competence in these settings.

Michigan Dentists' Attitudes toward Medicaid and an Alternative Public Dental Insurance System for Children.

PURPOSE: Healthy Kids Dental (HKD) was created as a pilot program of the Michigan State Medicaid program to increase access to care for Medicaid-eligible children. The purpose of this study was to evaluate dentists' attitudes toward Healthy Kids Dental and Medicaid in Michigan. METHODS: An online survey was sent to practitioners with an email address registered with the Michigan Dental Association (n=4,285). RESULTS: Surveys were returned from 965 practitioners (~23 percent). Although practitioners were not fully satisfied with HKD, their satisfaction with the program was significantly higher than their satisfaction with the traditional Medicaid program (P<.001). Sixty-four percent of providers that accept Medicaid limit the number of children seen in some manner, while 28 percent of providers that accept HKD limit the number of children seen. Families with traditional Medicaid who contact an office are significantly less likely to receive treatment for their child than families with HKD insurance who contact the same office (P<.001). CONCLUSIONS: Practitioners were more satisfied with programmatic and patient-related factors of the Healthy Kids Dental program than they were with Medicaid. Dentists were more likely to treat children with HKD than children with Medicaid when the parent contacts a dentist in Michigan.

Michigan dentists' attitudes toward Medicaid and an alternative public dental insurance system for children.

PURPOSE: Healthy Kids Dental (HKD) was created as a pilot program of the Michigan State Medicaid program to increase access to care for Medicaid-eligible children. The purpose of this study was to evaluate dentist's attitudes toward Healthy Kids Dental and Medicaid in Michigan. METHODS: An online survey was sent to practitioners with an e-mail address registered with the Michigan Dental Association (N=4,285). RESULTS: Surveys were returned from 965 practitioners (~23 percent). Although practitioners were not fully satisfied with the HKD, their satisfaction with the program was significantly higher than their satisfaction with the traditional Medicaid program (P<.001). Sixty-four percent of providers that accept Medicaid limit the number of children seen in some manner, while 28 percent of providers that accept HKD limit the number of children seen. Families with traditional Medicaid who contact an office are significantly less likely to receive treatment for their child than families with HKD insurance who contact the same office (P<.001). CONCLUSIONS: Practitioners were more satisfied with programmatic and patient-related factors of the Healthy Kids Dental program than they were with Medicaid. Dentists were more likely to treat children with HKD than children with Medicaid when the parent contacts a dentist in Michigan.

Community-based dental education and dentists' attitudes and behavior concerning patients from underserved populations.

The objectives of this study were to explore how dentists with well-structured vs. not well-structured community-based dental education (CBDE) experiences differ in perceptions of their CBDE and its impact on their professional lives and in their professional attitudes and behavior related to treating patients from underserved populations. The relationships between CBDE evaluations and impact on the dentists' professional lives and professional attitudes and behavior were explored as well. Data were collected from 254 dentists who participated in CBDE before graduating from the University of Michigan School of Dentistry between 1970 and 2011. The results showed that the alumni with well-structured experiences rated the quality of their CBDE more positively and its impact on their professional lives as stronger than those with less well-structured experiences. They also had more positive attitudes concerning treating underserved patients and were more likely to treat underserved patients than their peers with less well-structured experiences. These dentists' perceptions of the quality of CBDE and impact on their professional lives correlated significantly with their attitudes and behavior concerning treating underserved patients. Their perceptions of the quality of their CBDE experiences and perceptions of benefits from these experiences were significantly related to their professional attitudes and behavior related to providing care for patients from underserved populations.

Influence of community-based dental education on dental students' preparation and intent to treat underserved populations.

This study examined the influence of community-based dental education (CBDE) on dental students' perceived ability to treat underserved patients and their selection of community dental clinics as a first career path. In a 2009 survey, fourth-year dental students at the University of Michigan recorded their attitudes, skill level, and confidence in treating underserved patients before and after CBDE rotations and estimated what percentage of their practice they planned to devote to Medicaid-eligible patients. The first career choices of graduates from 2005 to 2010 were also correlated with the number of weeks the students spent in CBDE rotations. The results showed an improvement in student skill and confidence in treating low-income patients after the rotations. The examination of first career choices showed that, after three to five weeks of CBDE rotations, 5.6 percent of the students planned to practice in a community-based dental clinic. However, in 2009 when rotations were increased to eight weeks and included multiple clinic types, 11.8 percent of the students in 2009 and 16.5 percent in 2010 selected a community-based dental clinic as their preferred practice location. These findings suggest that CBDE improves dental students' skill and confidence level in treating underserved patients and that more time spent in CBDE rotations, specifically more than five weeks in multiple clinic types, may increase the number of graduates who select practice in community-based clinics as a first career choice.

Dental school and community clinic financial arrangements.

In community-based dental education programs, student-provided services can be an important source of community clinic and practice revenues. The University of Michigan School of Dentistry has developed a revenue-sharing arrangement with multiple community clinics and practices. During their ten-week externship, senior students produce at least $800 a day in patient care revenues, and the school receives an average of $165 per student per day from community sites. These funds are used to cover program costs and enrich the curriculum. Revenue-sharing with community clinics and practices helps to ensure program longevity and is an increasingly significant source of school revenues.

Development of a sustainable community-based dental education program.

Increasing the use of community-based programs is an important trend in improving dental education to meet the needs of students and the public. To support this trend, understanding the history of programs that have established successful models for community-based education is valuable for the creation and development of new programs. The community-based education model of the University of Michigan School of Dentistry (UMSOD) offers a useful guide for understanding the essential steps and challenges involved in developing a successful program. Initial steps in program development were as follows: raising funds, selecting an outreach clinical model, and recruiting clinics to become partners. As the program developed, the challenges of creating a sustainable financial model with the highest educational value required the inclusion of new clinical settings and the creation of a unique revenue-sharing model. Since the beginning of the community-based program at UMSOD in 2000, the number of community partners has increased to twenty-seven clinics, and students have treated thousands of patients in need. Fourth-year students now spend a minimum of ten weeks in community-based clinical education. The community-based program at UMSOD demonstrates the value of service-based education and offers a sustainable model for the development of future programs.