In this month’s letter, ADEA Executive Director Dr. Rick Valachovic considers the continued importance of bricks and mortar facilities in an era of pedagogical and technological change.
It’s traditional at this time of year to focus on sharing some good news, and this Charting Progress won’t disappoint. An event that took place earlier this year at the Arizona School of Dentistry & Oral Health (ASDOH) calls for a celebration. That event was the graduation of six American Indian dental students—a record number both for ASDOH and for dental education.
“When we started the dental school 12 years ago, there were 98 American Indian dentists in the whole United States,” Dr. Jack Dillenberg, ASDOH Dean, reminded me when we recently spoke. “We’ve graduated six in one year. That’s amazing!”
If you know Jack, his enthusiasm won’t surprise you, but I have to agree that amazing is not too strong a word, especially when you consider that only 17 American Indians enrolled as first-year students in all ADEA member dental schools in the fall of 2011. This number may not be exact because students self-identify their race and ethnicity, and a growing number of them report they belong to more than one racial group. Nevertheless, the number is startlingly low, and it is further dwarfed by the magnitude of oral health disparities within the American Indian community.
Investigators from the Center for Native Oral Health Research (CNOHR) at The University of Colorado Denver report that among American Indians—and also Alaskan Natives—preschool children have three times more untreated tooth decay than their general-population peers; adults have significantly more periodontal disease; and nearly a quarter of those over age 65 are edentulous. Reports also indicate that racial and ethnic minority providers are “more likely to serve in minority and medically underserved communities,” so increasing the number of American Indian dentists and other oral health professionals should be part of our efforts to address these disparities.
ASDOH is not the only school making a concerted effort to recruit and retain American Indian students. Creighton University School of Dentistry has had a decades-long relationship with several American Indian communities and currently has 12 American Indian students matriculated. For many years, the University of Oklahoma College of Dentistry invested in a center to support American Indian students academically. The college currently has six enrolled. (Historically, this number has been even higher.)
Nevertheless ASDOH’s 2012 cohort of American Indian dental graduates is unprecedented, and it has not occurred by accident, but by design. More on that in a minute, but first I’d like to introduce you to two members of the ASDOH class of 2012.
Dr. Zellisha Quam grew up on the Zuni Reservation in New Mexico. Today, she is taking part in an Advanced Education in General Dentistry (AEGD) program at the University of New Mexico (UNM) in Albuquerque, where she plans to work for the U.S. Indian Health Service (IHS).
Dr. Cheryle Singer grew up on the Navajo Reservation in Arizona. Today, she resides in her hometown and works at another IHS facility, the Hopi Health Care Center, about an hour away. Both women recall when they first set their sights on a career in dentistry.
For Zellisha, who was studying biology and chemistry at the University of New Mexico, that moment came while she was shadowing a Navajo dentist at the Albuquerque Area Indian Health Service and became aware of the huge oral health disparities among American Indians. Her sense of herself as a future health care professional was kindled even earlier when she met an American Indian physician for the first time.
“She was a resident in internal medicine so, of course, I was thinking highly of her,” Zellisha told me, “but when she said, ‘I used to herd sheep with my uncles,’ I said, ‘Wow, so did I.’ That was an epiphany. I thought the dream to become a doctor isn’t so big after all. I can do it, too.”
Cheryle—who put her dental hygiene career plans on hold when she became pregnant while at community college—spent eight years as a dental assistant. She thought her boss’s suggestion that she consider a career in dentistry “absurd,” until she met an American Indian dentist, Dr. Craig Bruce, and his wife Diana. They also encouraged her to consider a career in dentistry and connected her with the Society for American Indian Dentists, inspiring her to seriously consider dentistry for the first time.
“I looked into the prerequisites,” she told me, “and basically all I needed was organic chemistry, biochemistry, and my physics so, I was like, let’s try this and see what happens.”
Before long, both women were roommates and first year students at ASDOH. Both freely admit that the first year was stressful. Neither had experience grappling with the high intensity modular curriculum and weekly final exams. While praising the support of other American Indian students who helped them through, Zellisha mentioned being apprehensive at first about the challenges that lay ahead, and Cheryle, who grew up in a very remote area, said she found the city overwhelming. Attending ASDOH was the first time she was not in school with other Navajos, and she longed to speak her language or talk about things going on back home.
“There were times when I did want to quit, when I just wanted to come home,” she told me, but quickly added that the staff and administration were—here’s that word again—amazing. “They made it a point to reach out to me, just assuring me that they’re there to help me succeed. Just having that voice all the time and being able to depend on my director or my advisor, that really made a huge difference and put my mind at ease.”
Recruitment and retention of underrepresented minority students into the health professions is a central priority at ASDOH and its parent institution, A. T. Still University (ATSU). In fact, the University has tapped Dr. Christopher Halliday, another dentist with strong ties to the American Indian community, to lead its new dental school in Kirksville, Missouri. Having served as the Chief Dental Officer of the Indian Health Service for many years, this retired rear admiral from the U.S. Public Health Service will be well positioned to continue the recruitment efforts modeled on ATSU’s Arizona campus.
Given ATSU’s commitment to serving the underserved, it’s not surprising that community-based education has been part of ASDOH’s predoctoral program from the start. Fourth-year students spend 50% of their time in the field, some of them on Indian reservations. ASDOH students also earn M.P.H. degrees. As Jack likes to say, the school is in the business of training community health leaders and, along the way, teaching them to be great doctors, a phrase he acknowledges began with Dr. Arthur A. Dugoni at the University of the Pacific.
That philosophy has informed the school’s admissions policies. ASDOH selects students based as much on their demonstrated willingness and desire to serve the community as on their academic prowess. Their selection criteria show. ASDOH’s first seven classes averaged between 500 and 691 community service hours per admitted student, with some students logging more than 2,000 hours. As for more traditional measures, ASDOH has put dental school within reach of less academically accomplished students by setting its minimum grade point average (GPA) at 2.5, below that of many other dental schools, and deemphasizing the Dental Admission Test (DAT), since minority applicants have typically not scored well on these standardized exams.
But these policies are only part of the reason ASDOH has become a leader in graduating American Indian dentists. Much of the school’s success in this area must be credited to Jack’s decision to invite one man to join the ASDOH team at the school’s inception, and to empower him to recruit American Indian students and mentor them along the way.
It’s tempting to call Dr. George Blue Spruce, Jr. ASDOH’s secret weapon, but neither word feels right. He was highly visible throughout his career—even before he became the nation’s first American Indian dentist in 1956—and he is indisputably a force to be reckoned with. The reason behind Dr. Blue Spruce’s recruitment success? He understands students’ challenges because he himself experienced them.
It’s hard to summarize a career as varied and distinguished as Dr. Blue Spruce’s. (For that I recommend his memoir.) But to appreciate his current role as Assistant Dean for American Indian Affairs at ASDOH, you should know a few facts. In addition to being the first American Indian dentist, Dr. Blue Spruce was tapped to direct the first federal program aimed at recruiting and retaining ethnic minority students in health professions programs in the 1970s. A full 19 years after he himself received his D.D.S., Dr. Blue Spruce helped the nation’s second American Indian dental student graduate in 1975. He has continued to mentor young American Indians, in his position both as a former commissioned officer in the U.S. Public Health Service and as the founder and first president of the Society of American Indian Dentists (SAID).
Like Zellisha and Cheryle, Dr. Blue Spruce remembers the day when he first set his sights on dentistry. A kind man—who was also a community leader—encouraged Dr. Blue Spruce, then a shy fifth grader, in a bicycle race. Turned out the man was the local dentist. Dr. Blue Spruce is also quick to point out that his own remarkable career would not have been possible without his parents’ support. Both attended one of the notorious boarding schools that plucked Indian children out of their home communities and suppressed their languages and cultures in an effort to prepare them for vocational careers and assimilate them into the dominant society.
Dr. Blue Spruce’s parents made a decision early in their married life that all of their children would receive the type of education that would prepare them for college. They enrolled him in a Christian Brothers School, and from there he went on to Creighton University and Creighton University School of Dentistry. Dr. Blue Spruce has only praise for the education he received, but he still vividly recalls the pain of being far from home and the sting of being an object of curiosity as the lone American Indian on campus.
While today’s native students are less likely to be asked if they grew up in a teepee, Dr. Blue Spruce says stereotypes persist. The students he mentors still come to him with astonishing stories of their classmates’ perhaps well-intentioned but ignorant questions.
Homesickness also dogs many of today’s students. As Cheryle told me, ”I thought the hardest part of the whole thing would be getting into dental school, but leaving the reservation and my family, my two daughters to pursue my degree, that was probably the worst part of all of it.”
On the positive side, the desire of American Indian students to remain close to home is part of what propels them to return to their reservations and treat the people who so desperately need their services. Non-Indian dentists choose this path as well and are welcomed by the Indian Health Service, but they rarely bring the language skills and level of cultural sensitivity that characterizes those who are native to the reservation. Those are unique attributes that our schools might choose to recognize as they shape their admissions policies with an eye toward meeting workforce needs and addressing disparities.
“There are very few schools that want to say, look, we need more American Indian dentists, so let’s make accommodations for them to succeed in school,” says Dr. Blue Spruce, pointing out that many American Indian students graduate from high school without the math and physical and life sciences courses needed to be competitive applicants.
Even for those who are educationally prepared, the cost of dental school can be a barrier. (That’s true, of course, for all of our potential applicants.) The good news is that scholarships and loan forgiveness programs are available for American Indian students willing to work for the Indian Health Service for a period of time. The unfortunate news is that many qualified applicants are choosing instead medicine, pharmacy, and non-health professions, such as engineering.
“I’m running into very qualified American Indian students who say dentistry takes too long,” Dr. Blue Spruce told me. “They say, I can get a degree in engineering or one of the other professions in four years or maybe six and make more money than a dentist does.”
Fortunately, Dr. Blue Spruce is not the only American Indian dentist out there recruiting these days. ASDOH has graduated a total 16 American Indian students. Five are engaged in graduate study and the other 11 are working in Indian communities, where they can spread the word about dental careers to their younger counterparts. No doubt the American Indian graduates from other dental schools are doing the same.
“It’s great for the profession, great for oral health,” Jack told me, “because now we have role models and leaders out there who can be ambassadors, who can encourage other young American Indian men and women to come into dentistry.”
So while ASDOH’s success is something we all can celebrate, clearly, much work remains to be done, and dental schools on the whole will have to do more if the number of American Indian graduates is to multiply. Their numbers in this year’s ASDOH graduating class may be amazing, but wouldn’t it be even more amazing to see this success leveraged at schools throughout the United States and Canada? If your school is interested in working to repeat ASDOH’s success, I know Jack Dillenberg, George Blue Spruce, Chris Halliday, and ASDOH’s recent grads will be happy to help.