School of Health Management Arizona School of Dentistry & Oral Health

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1 School of Health Management Arizona School of Dentistry & Oral Health

2 Preparing Tomorrow s Dentist by Infusing Dental Public Health into the Dental School Curriculum Don Altman, DDS, MPH, MBA, MA, DHSc Chair, Department of Public Health Director, Public Health & Research

3

4 A. T. Still University of Health Sciences Kirksville College of Osteopathic Medicine (KCOM) Arizona School of Dentistry and Oral Health (ASDOH) Arizona School of Health Sciences (ASHS) School of Health Management (SHM) School of Osteopathic Medicine School in Arizona (SOMA)

5 ASDOH MISSION The mission of the Arizona School of Dentistry & Oral Health is to educate caring technologically adept dentists who become community and educational leaders, serving those in need.

6 Selection Our profession IS who we accept. We can teach almost anyone to be a good dentist, what we cannot teach is HEART. Dr. Jack Dillenberg, Dean

7 SHM MISSION The School of Health Management (SHM) serves as a learning centered school dedicated to preparing leaders in the health professions who promote socially responsible practice, policy, and research to improve prevention, wellness, and access.

8 Community Oral Health Integrated into the curriculum from the very beginning Did not have to retrofit into an established, full curriculum Some of the curriculum is after hours

9 Three Prong Approach PUBLIC HEALTH THEORY Require students to complete a Certificate in Dental Public Health. SERVICE LEARNING ACTIVITIES Community Service Learning Requirements during last 3 years of Dental School. CLINICAL ROTATIONS IN UNDERSERVED COMMUNITIES 4th year clinical experience at least 50% in external community rotations.

10 Certificate in Public Health dental emphasis 5 courses Introduction to Dental Public Health Behavior Sciences and Educational Concepts Dental Epidemiology Global Health Issues Financing Dental Care Completed with ATSU/ School of Health Management All Online D2 D3 Required for Graduation

11 Dual Degree Students From Dual Degree Students 15 Residencies 4 Military 5 Unknown Class of Dual Degree Students 13 Residencies 4 Military 5 Unknown

12 Three Prong Approach PUBLIC HEALTH THEORY Require students to complete a Certificate in Dental Public Health. SERVICE LEARNING ACTIVITIES Community Service Learning Requirements during last 3 years of Dental School. CLINICAL ROTATIONS IN UNDERSERVED COMMUNITIES 4th year clinical experience at least 50% in external community rotations.

13 Dentistry in the Community (Service Learning) Projects and Participation Each student must participate in at least 3 Community Oral Health activities each year. At least one of these activities must involve the student s direct, active participation in planning AND carrying out the activity (Project D2 and D3). Two of these activities may be observation or attendance only (Community Participation).

14 Dentistry in the Community (Service Learning) Projects and Participation Examples of current Projects: Training of case workers in oral health education at an outreach program for vulnerable pregnant women. Collaboration with a community medical clinic and Promotoras at a community services organization to conduct screening, oral health education, oral health data collection and treatment referral in a low income community. Education on sports related injuries and mouth guard use at a Boys and Girls Club. Screening and oral health promotion targeting the local Asian community.

15 Dentistry in the Community (Service Learning) Projects and Participation Student Comments: It is imperative that we, as dental professionals, do what we can (and in my opinion, what is right) to help those that may not be able to receive treatment for themselves or for their family. During this project, we were able to demonstrate those important points.... Since this project, I have made it my goal to do more than the required participation. It simply reconfirmed for me my desire to always be involved on a community level with the development of educational programs, and outreach programs to help those in need.

16 Three Prong Approach PUBLIC HEALTH THEORY Emphasize public health education and activities throughout dental school. SERVICE LEARNING ACTIVITIES Community Service Learning Requirements during last 3 years of Dental School. Require students to complete a Certificate in Dental Public Health. CLINICAL ROTATIONS IN UNDERSERVED COMMUNITIES 4th year clinical experience at least 50% in external community rotations.

17 ICSP ICSP = Integrated Community Service Partnership At least 50% of the 4 th year clinical education is done at external sites Starting in the 4 th year student completes 4 rotations of 4 6 weeks in duration Each external rotation is followed by an equal amount of time in the ASDOH clinic about 95 days in the community clinic Participation in all assigned rotations is required but the student must complete a minimum of two (2) rotations for their graduation requirement

18 Types of Sites FQHC: 39 Other Community Non profit: 10 Tribal Clinics: 6 IHS: 3 VA: 1 Homeless: 1 Portable/ Mobile 2

19 ICSP sites to which students are assigned for Alaska 1 New Mexico2 Arizona 17 Ohio 1 California 5 Oklahoma 1 Colorado 4 Rhode Island 1 Idaho 1 South Dakota 1 Louisiana 1 Texas 2 Maryland 1 Utah 2 Maine 4 Washington 6 Missouri 1 Wisconsin 1 Montana 2

20 ICSP Rotation Benefits For Student Exposure to a variety of community and public health based clinical environments and situations. An opportunity to be taught and mentored by excellent clinicians. Student competence and confidence dramatically increased. A deeper understanding of the unique oral health challenges faced by many communities, and the opportunity to learn first hand how to address those challenges.

21 ICSP Rotation Benefits For Site The dental staff has the opportunity to share their expertise and experience. The experience that the student receives at the site can be a very effective recruiting tool. All revenue produced by the student is retained by the site. The organization has the opportunity to be a partner with us in educating future dental professionals about cultural, societal and health issues unique to the community they serve. Sites report that students can produce as much as $10,000 $16,000 in a 4 6 week rotation.

22 ICSP Rotation Site Feedback Survey ASDOH students contribute to our overall clinical operation. Strongly Agree or Agree 89% ASDOH student are valued by our providers. Strongly Agree or Agree 97% ASDOH student are valued by our staff and our administration. Strongly Agree or Agree 95% ASDOH students are valued by the patients and the community we serve. Strongly Agree or Agree 96% ASDOH students contribute to meeting our organizations mission and goals. Strongly Agree or Agree 91% ASDOH and its students are seen as a potential source of providers. Strongly Agree or Agree 96% Participation with ASDOH and its students is seen as a positive retention tool. Strongly Agree or Agree 83% Describe the fiscal impact of student participation with your organization Positive 42% Neutral 47% Negative 12%

23 Feedback from CHC Sites They understand the concepts of public health dentistry. Students are well trained, and we have hired ASDOH graduates. We have hired from our students that have rotated through and recently received a call from one of our students who didn't sign with us wondering if there was an opportunity available. Intrinsic benefits balanced by financial/time consideration. Positive fiscal impact. Externs generate income for the clinic which surpasses the cost of housing. We are able to utilize students to impact our bottom line in a positive manner.

24 Feedback from Students I finally figured out what I want to do with my life: I suspected that I would like working in public health, but I had no idea that I would love it. I am convinced that community health center is a great place for me to begin my dental career, and the perfect opportunity to give back to the community. I had already decided earlier in the year that I would like to finish my MPH after graduation, so I think that I have that part of my life figured out.

25 Graduate Survey question survey sent to ASDOH graduates Four graduating classes ( ) 215 graduates survey to 208 (7 have no contact information) Survey was anonymous and conducted electronically (Zoomerang) Survey was conducted in January 2011

26 Results 94 surveys returned 45% response rate 46% enrolled in a specialty training program or residency 43% returned to their home state 27% reported working in a rural area 55% reported that they do, or have, practiced in a community based (e.g. military, CHC, hospital, etc.)

27 Results 72% reported that before entering dental school, one of their professional objectives was to treat underserved populations (or in an underserved area). 76% reported that they currently volunteer and 81% of those that volunteer, volunteer up to 9 hours a month

28 Results 57% graduated with more than $250,000 in debt 58% reported that the debt influenced their practice choice with most of those responses pointing to the ability to get loan repayment as a reason or working in a community based setting

29 My dental school experience prepared me well: To treat pts from socio economically disadvantaged backgrounds To treat pts from different ethnic/ racial groups To treat pts with disabilities 94% strongly agreed or agreed 87% strongly agreed or agreed 83% strongly agreed or agreed

30 My dental school experience prepared me well: To treat pts in different types of communities To gain insight into the barriers to oral health care 90% strongly agreed or agreed 92% strongly agreed or agreed

31 In my professional life I treat: Pts. from socioeconomically diverse backgrounds Underserved pts. 79% strongly agree or agree 78% strongly agree or agree

32 Agree or Disagree Likert Scale My certificate or masters in dph helped prepare me for my career in dentistry My participation in DIC projects prepared me for a career in dentistry My D4 clinical rotations prepared me for my career in dentistry 54% 65% 98%

33 In general, I feel that the community dental curriculum has influenced my dental practice choice Agree or Strongly Agree 85% Neutral 12% Disagree or Strongly Disagree 3%

34 There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in it success, than to take the lead in the introduction of a new order of things because the innovator has for enemies all those who have done well under the old conditions. but only lukewarm defenders in those who may do well under the new. Niccolo Machiavelli

35 Don Altman, DDS, MPH, MBA, MA, DHSc Chair, Department of Public Health Director, Public Health & Research School of Health Management/ Arizona School of Dentistry & Oral Health

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