Diversifying the Dentist Workforce, One Cohort at a Time

In this month’s letter, ADEA Executive Director Dr. Rick Valachovic celebrates a milestone in the history of a program that now involves ADEA and is contributing to the diversity of our dental schools.

Rural Nebraskans now have one more dentist they can rely on, and next year, underserved urban New Jersey residents may be able to say the same. Where did these new practitioners come from? Why have they chosen to practice where they have? Part of the credit goes to the Summer Medical and Dental Education Program (SMDEP), which celebrated a landmark event last month: the graduation from dental school of the first cohort of SMDEP dental scholars.

In case you’re not familiar with the program, SMDEP is a free six-week academic enrichment program that helps qualified undergraduate students from minority and disadvantaged backgrounds compete successfully for medical and dental school admission. (For more details, see “Today’s Student’s—Tomorrow’s Colleagues” in the August 2007 edition of Charting Progress) The program, formerly known as the Minority Medical Education Program (MMEP), was initiated and funded by the Robert Wood Johnson Foundation (RWJF) in 1987 to serve premedical students from underrepresented minority groups. Predental students were welcomed into the program as dental scholars on a pilot basis in 2005.  ADEA and the Association of American Medical Colleges (AAMC) now lead the program, with nine dental schools among the 12 program sites that host SMDEP scholars.  I serve as a director of the SMDEP along with Dr. Marc Nivet at AAMC.  Dr. W. David (Dave) Brunson here at ADEA serves as the dental deputy director.

Some of you may remember Ms. Jazmin Floyd from a previous Charting Progress. I spoke to the Elizabeth, New Jersey, native two years ago when she was studying at the University of Medicine and Dentistry of New Jersey (UMDNJ). Dr. Floyd, who graduated on May 23, will be entering a general practice residency program at Mountainside Hospital in Montclair, New Jersey, this July. She is not certain where she will go from there, but she knows this much: “I want to remain in an urban community, and I want to give back.”

Dr. Floyd’s resolution is good to hear. One of the reasons SMDEP is helping underrepresented and disadvantaged students gain entry to medical and dental schools is to increase their representation in the practice community and thereby improve access to care.

As I write, we are still tallying the graduates, but I can tell you that 309 SMDEP scholars from the 2006-10 summer cohorts have enrolled in 53 different dental schools, and more than 1,000 have participated in the program as dental scholars.  Many of these are still completing their college degrees.

I wanted to hear RWJF’s perspective on this recent milestone in SMDEP’s history, so I called Foundation Program Associate Ms. Andrea Daitz, who oversees SMDEP. She told me that from RWJF’s point of view, the program is still evolving.

“The challenge is always, ‘How do we reach the students we want to reach, and how do we define those students?'” Andrea told me. “We want to make sure that people from all backgrounds have an opportunity to bring a range of perspectives to health care so they really reflect the diversity of our nation and benefit all Americans down the road.”

The program’s evolution reflects the Foundation’s efforts to address this challenge. MMEP’s initial focus on minority students was broadened in 2003 to include low-income students and those from rural areas, and its name was changed to Summer Medical Education Program (SMEP). These new admission criteria, and the inclusion of dental scholars two years later, opened the door for students like Mr. Andrew Benson, who is now Dr. Benson, a recent graduate University of Nebraska Medical Center (UNMC) and a 2006 UNMC SMDEP program participant.

Dr. Benson grew up on a farm in central Nebraska. He was one of 63 seniors at his small public high school. He entered Wayne State College (WSC) knowing that he wanted to pursue dentistry and heard about SMDEP from his chemistry teacher. When we recently spoke, he called the program “an eye-opener.” It encouraged him to make a firm commitment to dentistry while allowing him to see his strengths and weaknesses in relation to those of his peers.

Unlike many recent graduates who tend to cluster in and around big cities, Dr. Benson has chosen a rural practice that will allow him to meet his personal goals while helping a community that needs dental services.

“I wanted to be close to home so I could help farm,” Dr. Benson explained. “I like small-town life and the strong community feeling.”

This month he began work for a multisite dental firm and is splitting his time between the small city of Grand Island and an underserved town with a population of 1,000.

In addition to its contributions to creating a more diverse dental and medical workforce, SMDEP also has benefits for the educational institutions that host it and admit the program’s alumni.

“The students bring a richness to the class, in terms of where they come from geographically and the demographic distribution,” assesses Ms. Corky Cacas, who is the Director of Admissions for the University of Pennsylvania School of Dental Medicine (Penn Dental Medicine), adds, “We know that anyone going through the program is really ”

By way of example, she cites some SMDEP alumni who received merit scholarships at Penn Dental and one who was recently accepted into a dual-degree program. He will earn a degree in bioengineering along with his D.M.D. degree.

Dr. Patricia E. (Patti) Meehan, Assistant Dean for Admissions and Recruitment at the University of Maryland School of Dentistry, concurs with Corky Cacas’ assessment.  “We view participation in an academic enrichment program like SMDEP as a positive element of an admissions profile,” she told me. “Of our three graduating SMDEP seniors, all were very solid contributors academically, and two received awards in recognition of their outstanding community service and leadership during their four years here at Maryland.”

When SMDEP began, there was skepticism on some campuses that a six-week summer program would be enough to help educationally disadvantaged students gain admission to dental school, let alone succeed if they were admitted. With 53 of our schools having admitted former SMDEP scholars, it appears those fears are being laid to rest.

Dr. Ernestine S. (Ernie) Lacy, Director of the Office of Student Development at Baylor College of Dentistry (Baylor) will be happy to see the end of that skepticism.  Baylor has admitted many SMDEP alumni, not surprisingly since Ernie helped initiate the school’s eight-week, formal, in-depth predental summer enrichment program for college students in 1996.  Today, Baylor hosts a number of pipeline initiatives (see the February 2010 edition of the ADEA CCI Liaison Ledger), thanks largely to Ernie’s efforts and support throughout the Baylor ranks. She has seen dozens of students who were once considered educationally disadvantaged pass through Baylor’s doors and walk across the stage at graduation time.

“These students can come in on a level playing field and perform at the level of our other students,” she insists. “The programs are effective. They work!”

Clearly, SMDEP is achieving its primary mission of preparing underrepresented students for admission to—and success in—dental school, but the program has ancillary benefits as well. For starters, “Some of the medical and dental schools weren’t working together before,” Andrea Daitz (at RWJF) observes. “The fact that many now are has strengthened relationships among the schools within participating institutions.”

Of course, the ultimate test of SMDEP’s dental alumni has yet to come. Will their entrance into dental school ultimately position more oral health professionals in underserved communities? For now, SMDEP’s sponsors are betting that it will.  The Foundation is continuing its commitment for the long run, and AAMC and ADEA—along with SMDEP sites—are committed to refining the program’s delivery.

Each December, the SMDEP sites come together to share best practices. Most recently, the sites have been asked to focus more on regional recruitment, to connect with other pipeline initiatives that reach students in the precollege years, and to pilot a commuter component. This spring, the SMDEP Alumni National Advisory Board was formed to better connect former scholars to each other and to opportunities in keeping with the program’s mission.

“We want to communicate to the students that we expect them to stay in touch,” says Andrea, “and that we see them as leaders in their respective fields—whether in practice, in research, or in policy. They are the future of health care, and we really do expect incredible things from them in all areas.”

It’s wonderful to be associated with a program and an organization that both take the long view. Those of us in the health professions know all too well that the problems of workforce diversity and access to care are multifaceted and cannot be solved overnight. The Robert Wood Johnson Foundation—which celebrates its 40th anniversary this year—appreciates this fact as well. The Foundation—which invests methodically over the course of years, constantly evaluating and refining its programs— achieves some remarkable results.

The transformation of these first SMDEP dental scholars into dental school graduates marks another milestone in the Foundation’s deliberate effort to advance the nation’s health. Happy 40th, RWJF, and congratulations, SMDEP dental scholar graduates!  I, for one, hope you will remain connected to one another and continue to contribute to a more diverse workforce and improved access to care.

Getting in Step with Interprofessional Education

In this month’s letter, ADEA Executive Director Dr. Rick Valachovic considers how the interprofessional education imperative will help dental schools to establish closer relationships with their colleagues in the academic health center.

Fourteen years ago, in the aftermath of seven dental schools closing their doors, I sat down with several colleagues to discuss the relationship between dental schools and the universities that house them. These conversations coincided with the 75th anniversary of our Association and informed a paper that we published in the Journal of Dental Education on the topic. Its primary message?

[T]he good relationship between dental schools and their universities is not one that dental educators can afford to take for granted…. [T]he isolation on university campuses into which dental schools have occasionally fallen in the past cannot be permitted if they are to survive and thrive.

“Dental schools will embrace the IPE movement to ensure their leadership roles within the academic health center.”

This concern came back to me last month as I pondered our collective future in an era when interprofessional education (IPE) will be widely introduced in many of our academic health centers (AHCs). The AHC has traditionally functioned as a collection of individual schools of the health professions, but on many campuses we are now seeing significant cross-fertilization. The University of Colorado, with its new integrated Anschutz Medical Campus immediately springs to mind, but I could name many other examples. The new Commission on Dental Accreditation Standard 1-9, which requires that “the dental school must show evidence of interaction with other components of the higher education, health care education and/or health care delivery systems,” will help guide more of our schools in this direction.

While our community is well aware of the relationship between oral health and overall well-being and we can boast of our involvement in many interprofessional initiatives, there’s no getting around the fact that dentistry as a whole has had difficulty integrating its educational programs with the other health professions. This difficulty reflects dentistry’s historic isolation. Setting ourselves apart may have some advantages, but to my mind, we do so at our peril.

Team-based health care is already a reality for a growing number of Americans who receive their care through integrated health care providers like Kaiser Permanente ^®, Geisinger Health System, and the U.S. Department of Veterans Affairs. The Marcus Welbys of the world are now in the minority, with 51% of American physicians employed by others. What is more, these employers are coming to AHCs and saying that they’re concerned about the cost of retraining recent graduates to work more collaboratively in a team-based approach to caring for patients.

I discussed these realities with our outgoing ADEA President Dr. Leo E. Rouse and our current ADEA President Dr. Gerald (Jerry) N. Glickman during a day-long program coordinated by the ADEA Leadership Institute Alumni Association at this year’s ADEA Annual Session & Exhibition. Leo pointed out that our Canadian colleagues are far ahead of us in IPE and warned that our Congressional supporters on Capitol Hill are becoming impatient. He reported that Senator Barbara Mikulski (D-Md.) keeps asking, “Can you all learn to get along?”

Jerry expressed concern about the existence of silos even within some departments in dental schools, and said he has started to see the merits of the comprehensive dentistry departments favored by some of our schools. When I asked him if he thinks dental schools stand to lose something if they don’t get involved with IPE, he replied, “We’ll be left in the dust.”

I hope by now you are all aware that our Association has been making a concerted effort these past few years to ensure that such a scenario does not come to pass. ADEA leaders Drs. Sandra C. Andrieu and Leo E. Rouse played key roles in formulating the Core Competencies for Interprofessional Collaborative Practice released last year at the National Press Club in Washington, D.C., by the Interprofessional Education Collaborative (IPEC). Since the core competencies’ release, IPEC has become a permanent force for change that is actively pursuing several exciting initiatives. The leaders of IPEC’s six affiliated associations, which represent educators in allopathic medicine, dentistry, nursing, osteopathic medicine, pharmacy, and public health, meet every week to discuss what is happening in our communities and what we need to do next. These weekly meetings signify an unprecedented commitment across our organizations to shaping a more interprofessional future for health professions education.

This month, IPEC leaders met with Dr. Mary Wakefield, the Director of the Health Resources and Services Administration (HRSA), to discuss our collaboration. We are meeting soon with Ms. Marilyn Tavenner, the Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), to discuss these issues as well. ADEA and the other IPEC associations are also founding sponsors and members of the Institute of Medicine Global Forum on Innovation in Health Professional Education, which aims to apply an ongoing, multinational, multidisciplinary approach to exploring promising innovations in health professions education, including IPE. You’ll be hearing more about this approach as the project unfolds in the year ahead.

Next week, IPEC will host its first faculty development institute, “Building Your Foundation for Interprofessional Education,” not far from Washington, D.C., in Herndon, Va. The institute will bring together teams representing a minimum of three health professions to strategize about specific issues they are confronting in implementing IPE at their institutions and to create a plan for addressing them. Amazingly, six hours after opening registration, the institute sold out, and now an additional 60 teams are on a waiting list for a future institute.

“That in and of itself is the indicator that our schools are really ready to learn together about how to make IPE sustainable and have it reach the largest number of students,” Dr. Lucinda L. Maine commented when we last spoke. Lucinda is my counterpart at the American Association of Colleges of Pharmacy (AACP). The AACP has developed similar institutes over the years and is taking the lead in this initiative. Not surprisingly, pharmacy is well represented on the teams attending the institute. Pharmacy is a natural fit within IPE, since the use of medication cuts across most health-care encounters. But I am pleased to report that dentistry is also well represented, with 10 schools taking part.

In addition to its faculty development work, IPEC has plans to build an interprofessional portal within MedEdPORTAL, our collaboration with the Association of American Medical Colleges (AAMC). IPEC has also put out a call for submissions of new interprofessional resources, and the Josiah Macy Jr. Foundation has awarded grants to partially fund their creation. Yet another sign of our commitment to collaboration: All the IPEC member associations will be cosponsoring the fourth annual AAMC Integrating Quality Meeting. The program will bring together health care professionals, trainees, and students from our various professions to share strategies for enhancing the culture of quality in clinical care and health professions education.

All of these developments bode well for IPE; nevertheless, obstacles remain. Even within our fields, there are cultural divides based on training, philosophy, and conflicts over scope of practice. I spoke to Dr. Carol A. Aschenbrener, AAMC’s Chief Medical Education Officer, after she returned from the association’s annual meeting, and she had some interesting observations in this regard. Carol believes we have “profound work to do” to reshape the culture within our schools, but she sees significant rewards if we persist. She noted that in the past, concerns about bringing students together at different stages in their educations were commonly cited as reasons not to pursue IPE, but at this year’s AAMC meeting, she detected a growing awareness that mixing things up has its benefits.

“One of the benefits of putting first- and second-year medical students with nursing students in clinical settings is that the medical students quickly discover that the nursing students may have more clinical experience,” she told me.  “This discovery may be disconcerting at first, but they quickly acknowledge they can learn from each other. This awareness is the beginning of a different mental model—one that is more collegial and less hierarchical.”

The same can be said of all of our professions. Fortunately we now have a growing assortment of tools—the IPEC competencies, faculty development institutes, the soon-to-be released ADEA Study Group report, and additional resources in the MedEdPORTAL pipeline—to help us implement IPE.

Dental schools must embrace this movement if they want to ensure their leadership roles within the academic health center. In some cases, senior university leadership is insisting on it. In others, IPE is generating movement at the grassroots. Either way, dentistry needs to get in step. Connecting with our colleagues across the professions is not only good for our schools; it’s what’s best for the health of the patients we serve.