Destination Dental School

A Remote Pipeline Program to Increase Student Diversity

Thikriat Al-Jewair, D.D.S., M.S., FRCD(C); Jessica Scates, M.Ed.

ABSTRACT

Promoting diversity among dental school applicantsand enrollees is key to tackling oral health disparitiesand improving learning outcomes. Building the pipelinehas proven to be an effective method to increasediversity and heighten interest in dentistry amongstudents. Destination Dental School is an eight-weekremote pipeline program aimed at increasing diversityof historically underrepresented minority (HURM)students in the field of dental medicine. Pre- and postprogramsurveys showed that the program was effectivein fostering HURM students’ interest in dentistryand increasing their knowledge and preparedness fordental school applications.

According to the American Dental Education Association (ADEA), only 18.2% of applicants to dental schools for entry in 2020 were historically underrepresented minority (HURM). [1] Although this percentage has increased over the past decade, the change is modest, and the lack of diversity in the dental workforce remains a problem in the dental profession, and it is well below the proportions reported for minority groups (Black/African-American, Hispanic, American Indian and Alaskan native, Pacific Islander and Hawaiian) in the U.S. Census.

An abundance of research exists that highlights the importance of diversity in health professions, including dentistry. Promoting diversity among dental school applicants and enrollees is important for tackling oral health disparities, which are partly triggered by a lack of HURM dental providers who understand HURM communities’ needs. A previous study [2] of practice locations that involved senior dental students showed that a higher percentage (68.7%) of Black/African-American students planned to practice in inner-city locations near underserved populations compared to white students (20%). Another study [3] reported that Black/ African-American dentists provide care to a patient pool that is disproportionately black (44.9%).

Building the enrollment pipeline has proven to be an effective method to increase diversity and heighten interest in dentistry among students. [4,5] Although the percent increase in enrollment of HURM students has been marginal, this increase was reported to be greater in schools that offer pipeline programs as compared to those that do not. Several pipeline programs have resulted in an increase in diversity among dental school applicants and enrollees. [6,7] Despite the success of these programs, challenges still exist. In a recent qualitative study, Burns et al. [6] examined perceived barriers to dental school application among underrepresented pipeline program alumni. They found a lack of knowledge about the process and financial barriers, such as application fees and dental admission test (DAT) and interview costs, to be the major barriers.

The ongoing COVID-19 pandemic has resulted in a paradigm shift towards distance learning in dental education using syn-chronous and asynchronous online platforms. Similarly, in-person pipeline programs in dentistry [8] and other disciplines, such as radiology, [9] surgery, [10] cancer research [11] and STEM, [12-14] moved to partial or fully remote programming. A surgical training pipeline program that did not move to a virtual setting resulted in fewer applications than in previous years. [10]

Remote pipeline programming offers some benefits to students and organizers. Programs that shifted to remote learning saw an increase in the number and availability of faculty and industry mentors, as well as the number and demographic and geographic diversity of students who were able to participate. [11,12,15] The online environment was appropriate for certain activities, for example, mentorship meetings, [12] training in research [11] and dialogue-based activities [14] like case-based discussions. [15] Students joining remotely can access easy-to-use learning resources and feedback tools, such as Kahoot (Oslo, Norway), a game-based learning platform, and Padlet (San Francisco, CA), an online bulletin board. [13] And, finally, remote pipeline programs expand opportunities for universities or students with limited resources. [10,11] A recent study [7] compared virtual and in-person instruction for the semester-long Saturday Academy, a New York University College of Dental Medicine dental pipeline program, and found the virtual program to be as effective and impactful as the in-person one.

Remote pipeline programming also presents a number of challenges. Virtual environments can reduce a sense of community; [10] as such, program coordinators must find creative ways to engage with students online. [13] Resources, including technology and internet access, may not be equitably distributed or available [11,13] Additionally, disjointed collaboration and communication can contribute to unclear expectations for students [11,13] Finally, virtual environments limit opportunities for students to engage in different types of research projects, [10] as well as complete hands-on-activities, [10,11,14] a component that is especially important for dental education.

Destination Dental School

In summer 2021, the University at Buffalo School of Dental Medicine (UBSDM) Office of Equity, Diversity and Inclusion launched Destination Dental School (DDS), an eight-week remote pipeline program aimed at increasing diversity of students in the field of dental medicine. The program’s objectives included: increase students’ understanding of the day-to-day life of a dentist and a dental student; strengthen their future dental school applications; and develop their research and interview skills.

Students were recruited to this program through indirect and direct recruitment methods. The program description and application were published on the UBSDM website. The University at Buffalo published an article announcing the launch of the DDS program in its online newspaper UB Now, a daily publication for UB faculty and staff with a mailing list of over 7,000; and an article was published in the American Dental Association News.

Direct recruitment included email campaigns to colleagues, peers and organizations. To apply to the program, interested individuals completed and submitted an online application form, personal statement, resume, academic transcript and two letters of recommendation. The program’s admissions committee reviewed and scored application packages. Eligibility criteria included a level of education (undergraduate or post-baccalaureate) and identification as a HURM for the field of dentistry.

Program Description

The remote DDS program was held weekly, in three-hour sessions every Saturday throughout June and July 2021. All sessions utilized online platforms for teaching and learning: Zoom for weekly meetings and Miro (San Francisco, CA), an interactive, online whiteboard, for asynchronous activities, weekly feedback and resource sharing. Students participated in an orientation meeting to get to know one another, ask questions before the start of the program and complete the pre-course survey.

Twelve faculty, alumni and staff supported the 2021 DDS program. Faculty and alumni led case presentations about the different disciplines in dentistry, including anesthesiology, endodontics, general practice. orthodontics, pediatrics, periodontics, prosthodontics, public health and radiology, and also outlined their career paths and experiences in dental school. Students received supplies through the mail from the UBSDM so they could participate in faculty-led, virtual hands-on-activities, an important and popular portion of the program. Hands-on activities included carving tooth anatomy, and completing direct restorative fillings on 3-D printed models and alginate impressions of teeth. University at Buffalo Admissions staff presented an information session on the admissions process and financial aid. Additionally, 21 dental students supported the 2021 DDS program by leading DAT guidance sessions, conducting 1:1 mock interviews and participating in panel discussions. Finally, students honed their research skills by developing and presenting a team-based capstone research project using the PICO model (P: Patient/Problem; I: Intervention; C: Comparison; O: Outcome).

For program monitoring and evaluation, students submitted weekly, anonymous feedback using “I Like” and “I Want” prompts on Miro (San Francisco, CA). Program leadership reviewed the feedback after each week and made necessary adjustments to the program’s content and design. This continuous feedback loop ensured the program’s relevance and appropriateness.

Students also completed pre- and post-program surveys to measure their perceived knowledge of dental medicine, the application process for dental school and the DAT; perceived preparedness for and likelihood of applying to dental school; and perceived interview and research skills. A survey instrument was developed specifically for this program. The survey tools were hosted on Google Forms (Mountain View, CA). The instrument included 10 questions: three focused on demographics; four Likertscale questions measuring perceived knowledge, preparedness and likelihood of applying to dental school; and three qualitative, open-ended questions focused on expectations for the program, as well as barriers and resources to apply to and attend dental school. The post-course survey instrument also included two questions focused on perceived ability to perform specific tasks and four questions related to program satisfaction.

DDS Program Outcomes Assessment

UBSDM received 51 applications and accepted and enrolled 24 students. The program’s cohort included students aged 19 to 30 from 15 states across the United States. Nineteen (86%) students were female; 5 (14%) were male. Race/ethnicity for program students was 16 (72%) African-American/black; 5 (22.7%) Hispanic/Latino/ Latinx; 2 (9%) mixed race/ethnicity; and 1 (4.5%) Native American. All students (100%) completed the program.

Figure 1. Pre- and post-survey responses on perceived knowledge.

Response rates to the pre- and post-surveys were 100% and 92%, respectively. Comparison of pre- and post-survey data revealed an overall improvement in all measures. Participants’ knowledge in “the field of den-tal medicine” increased from 37.5% (pre) to 90.9% (post). Similarly, “disciplines in dental medicine” 16.6% to 90.9%; “research in dental medicine” 0% to 86.36%; “day-to-day life as a dentist” 58.3% to 90.1%; “dental school application process” 37.5% to 86.4%; DAT 37.5% to 90.9%; and “strategies to improve dental school applications” 12.5% to 90.9% (Figure 1).

Data also revealed increases in preparedness to “apply to dental school” 45.8% to 68.2%; likelihood to apply “to dental school” 91.7% to 95.5%; and “to UB School of Dental Medicine” 91.7% to 95.5% (Figure 2).

Figure 2. Pre- and post-survey responses on perceived preparedness and likelihood of applying and attending dental school.

Figure 3 depicts changes in knowledge specific to skill sets. Students’ “interview skills” improved from 16.7% to 95.5%, and research skills improved from 25% to 86.4%. The majority (86.36%) of students noted change in their ability to give an evidence-based presentation, work effectively in a team, and develop hand skills; and 90.48% noted change in their ability to network/communicate.

Figure 3. Pre- and post-survey responses on perceived skills.

It is important to note the various barriers and resources that may impact DDS students’ ability to apply to and attend dental school. Table 1 shows responses from students when asked about barriers and resources to apply to and attend dental school. They identify finances, GPA and the DAT as the top three barriers to their applying to and attending dental school in both pre- and post-course surveys. Students also noted the need for a strong mentor/peer network, funding opportunities, additional DAT study resources, and information about the admissions process to successfully attend and complete dental school. In response to program satisfaction students said: “It exceeded my expectations. I was not expecting to be able to do hands-on activities considering the virtual nature of the program. I really appreciated every resource given to us.”

“DDS exceeded my expectations. The support from all of the program directors was amazing. Being able to connect with all of the participants from all over the country, as well as meeting with presenters from diverse backgrounds was truly inspiring and encouraging. I would recommend this program to everyone!”

“Destination Dental School increased my interest in the dental field, specifically dental research. The capstone project made me realize how much groundbreaking research can be made in the dental field. I had a lot of fun and was very interested in reading different resources for my capstone project.”

“My participation in DDS has not only increased my interest in the dental field but it has solidified my decision to become a dentist. I have a passion that I want to bring to my community. My goal is to help those around me as my success is also their success! MANY THANKS UB DDS!!!!”

The DDS leadership team will utilize pre- and post-course survey results to inform the curriculum for future pipeline programs. To evaluate the outcomes of the DDS program and its impact on the field of dental medicine at large, the UBSDM will request all DDS students to complete an annual outcome/impact survey. This tool will measure objective data, including DAT results, application, admission and acceptance to dental schools, and graduation from dental school.

Program tuition was fully covered by the UBSDM. Students who completed the DDS program received a waived application fee to the UBSDM and reimbursement for the DAT up to two years after program completion. In addition, eligible students received a stipend or Kaplan DAT study resources. The program received institutional funding and in-kind donations from UBSDM alumni and the industry, including the Phil Galeota family, Aspen Dental, Evolution Dental, Henry Schein Foundation, Ivoclar Vivadent and Kaplan.

Limitations and Future Recommendations The National Institutes of Health [16] has identified populations underrepresented in the scientific workforce to include underrepresented racial and ethnic groups, women, individuals with disabilities, individuals from disadvantaged backgrounds, and individuals from low socioeconomic status backgrounds. The inaugural DDS program inclusion criteria was narrow, with a focus on inclusion of applicants from HURM groups. For future DDS programs, the DDS application will include a broader inclusion criterion to ensure the program has a greater impact on diversity of the scientific workforce.

In response to what improvements can be made to the program, students cited a desire for more time to interact with one another, more intense study sessions for the DAT, more handson activities, more supply materials, and additional preparation for the dental school application process. Future programming will shift and change according to student, faculty and leadership input and in consideration of restrictions related to COVID-19.

Conclusion In conclusion, the DDS program was effective in fostering HURM students’ interest in dentistry, as well as increasing their knowledge and preparedness for dental school applications. Identifying and tackling barriers and challenges to dental school application and enrollment is important to capacitating a future dental workforce that is able to meet the needs of the communities they serve. p

Queries about this article can be sent to Dr. Al-Jewair at thikriat@buffalo.edu.

REFERENCES

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3. Mertz E, Calvo J, Wides C, Gates P. The black dentist workforce in the United States. J Public Health Dent 2017;77:136-47.

4. Formicola A, Bailit H, D’Abreu K, et al. The Dental Pipeline program’s impact on access disparities and student diversity. J Am Dent Assoc 2009;140:346-53.

5. Formicola AJ, D’Abreu KC, Tedesco LA. Underrepresented minority dental student recruitment and enrollment programs: an overview from the dental pipeline program. J Dent Educ 2010;74:S67-73.

6. Burns LE, Pezzullo C, Amable RJ, Mayorga L, Mejia EE. Assessing the pipeline: Perceived barriers to applying to dental school among pipeline program alumni. J Dent Educ 2021;85:157-65.

7. Burns LE, Pezzullo C, Dief S, Conde G, Mejia EE. Reimagining the pipeline: Saturday Academy at New York University College of Dentistry goes virtual. J Dent Educ 2021;85:1543- 53.

8. Burns LE, Pezzullo C, Dief S, Conde G, Mejia EE. Reimagining the pipeline: Saturday Academy at New York University College of Dentistry goes virtual. Journal of Dental Education 2021;85:1543-53.

9. Franco I, Oladeru OT, Saraf A, et al. RISE: an equity and inclusion-based virtual pipeline program for medical students underrepresented in medicine. International Journal of Radiation Oncology, Biology, Physics 2021;111:e8.

10. Santos-Parker JR, Santos-Parker KS, Caceres J, et al. Building an equitable surgical training pipeline: leadership exposure for the advancement of gender and underrepresented minority equity in surgery (LEAGUES). Journal of Surgical Education 2021;78:1413-8.

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12. Sanders E, Cruz L-A, Speidell E, et al. 11039 Indiana CTSI high-school STEM summer research program: future opportunities from a 2020 virtual program. Journal of Clinical and Translational Science 2021;5:63-.

13. Watts-Taffe S, Kirkendall A, Shaver N, et al. Virtual collaboration in the age of COVID- 19:supporting youth as co-researchers. Journal of STEM Outreach 2021;4:1-15.

14. Qua K, Haider R, Junk DJ, Berger NA. Sustaining student engagement–successes and challengesof a virtual STEM program for high school students. Journal of STEM Outreach2021;4:1-9.

15. Kahn JM, Sandhu N, Deig C, et al. Radiation oncology virtual elective rotation for medicalstudents and residents: implementation of a national virtual education resource. InternationalJournal of Radiation Oncology, Biology, Physics 2021;111:e7-e8.

16. National Institute of Health. Populations Underrepresented in the Extramural ScientificWorkforce. National Institutes of Health 2020.

Dr. Al-Jewair

Thikriat Al-Jewair, DDS, MS, FRCD(C), is assistant dean for equity, diversity and inclusion, director of advanced education program in orthodontics and associate professor at the University at Buffalo, Buffalo, NY. She is a diplomat of the American Board of Orthodontics and a fellow of the Royal College of Dentists of Canada.

Ms. Scates

Jessica Scates, M.Ed., is coordinator of equity, diversity and inclusion initiatives at the University at Buffalo School of Dental Medicine, Buffalo, NY.