Predicting Rural Practice and Service to Indigent Patients: Survey of Dental Students Before and After Rural Community Rotations

Community-based dental education in Iranian dental schools

BACKGROUND

Community-based dental education (CBDE) has been an essential advancement in dental education in recent decades, enhancing it in many aspects. This study aimed to determine the characteristics and improvements of CBDE in dental schools in Iran.

METHODS

In the present descriptive study, an electronic questionnaire, including 18 "yes/no", "multiple choice", and "short answer" questions about the nature and extent of CBDE and students' experience in CBDE, was used. In early 2021, the questionnaires were mailed to the deans of all 43 dental schools in Iran under the supervision of the Council for Dental Education of the Iranian Ministry of Health and Medical Education. Reminder calls were made after 6 and 12 weeks. Dental schools that did not follow the CBDE program were excluded. The responses were analyzed descriptively.

RESULTS

Thirty-six dental schools completed the questionnaire (response rate: 84%). Seventeen schools (47%) reported having CBDE in their dental program. Sites lacking a well-equipped dental setting were the most used out of all extramural sites. The number of weeks dedicated to CBDE ranged between 1 and 20 (median: 4). The most common dental procedures practiced in extramural sites were pediatric dentistry (100%), restorative dentistry (71%), and dental examination (59%). The student-to-supervisor ratio in CBDE ranged between 3 and 15 (median: 5). In most schools (65%), the staff involved in directing CBDE were Community Oral Health PhDs.

CONCLUSIONS

An increasing number of Iranian dental schools have integrated CBDE into their undergraduate dental curriculum. The characteristics and extent of this educational strategy vary widely among dental schools. CBDE can be more effective by making positive changes in dental programs.

Assessment of Dental Student Satisfaction after Internships in Collaborative Dental Practices in Saxony-A Retrospective Questionnaire Analysis

The goal for dental students of a university-based program should be to learn about practice procedures in a dental office as part of their studies in order to gain insight into day-to-day activities, such as organizational management, patient communication, and problem-solving strategies. All dental students from the Faculty of Medicine at the University of Dresden in Germany, who completed a one-week internship in an external dental office in the last year before taking the final exam, were invited to participate in the survey (total n = 182 in years 2017-2019 and 2022). After completing the internship, the students were asked to anonymously rate the distinctive competencies they had acquired during their dental studies in terms of clinical and social communication skills. The results of the survey showed a good practicability of the acquired dental knowledge and a general satisfaction of students during their internships. No significant influence of the COVID-19 outbreak and the resulting special regulations in dental practices during the pandemic on student satisfaction was found. Students were more satisfied with their completed internships in smaller cities. Therefore, a stronger inclusion of practices outside the big cities should be considered in the current implementation of the new Dental Licensure Act in Germany.

Motivations and experiences among dentists in rural private practice: A qualitative study

OBJECTIVES

Despite the critical importance of access to dental care for rural residents and concerns about a shrinking rural dentist workforce, few studies have examined rural dentist motivations to practice in rural areas. The aim of this study was to explore practicing rural dentists' motivations and experiences qualitatively through semi-structured interviews to help inform and guide recruitment and retention efforts in rural areas.

METHODS

Dentists were included in the sample frame if they were general dentists in private practice and had a primary practice located in a rural Iowa county. Rural dentists with publicly available email addresses were contacted by email to participate. Semi-structured interviews were administered to 16 private practice general dentists. All interviews were audio recorded, transcribed, and coded using pre-set and emergent codes.

RESULTS

Participants were most commonly male (75%), under age 35 (44%), white (88%), and practiced in a partnership arrangement (44%). The main codes regarding dentists' experiences and motivations to practice in a rural area included familiarity with a rural area, community, financial factors, and clinical care delivery. Having been raised in a rural area was a major influence in most dentists' decisions about where to locate.

CONCLUSIONS

The importance of rural upbringing in this study underscores the need to consider rural upbringing in dental student admissions. Additional findings, such as financial benefits of a rural practice and other practice-related factors can be used to inform recruitment efforts.

Process, outcome, and impact evaluation of the ohio state university DentPath postbaccalaurate program

Despite the progress in increasing racial and ethnic diversity in dental school programs in the United States, minority dental students still remain underrepresented when compared with the total population. As a result, dental education programs have been attempting to increase the number of students from underrepresented and underserved communities in their programs.

PURPOSE

The purpose of this study was to conduct process, outcome, and impact evaluations of the Ohio State University (OSU) College of Dentistry's (CoDs) DentPath Program.

METHODS

Upon Institutional Review Board approval, this study utilized a computer-assisted telephone interview research design of graduates from the OSU CoD DentPath Program. Forty closed and open-ended questions were asked during the structured interview. Descriptive and thematic analyses were used to analyze the data.

RESULTS

The data from 25 eligible graduates were analyzed, which represented a 100% response rate. Process evaluation revealed 100% (n = 25) of the participants expressed satisfaction with their DentPath experiences and recommendations for improvement were provided. Outcome evaluation revealed the participants treated patients using Medicaid (range: 20%-90%, n = 5) or a sliding scale (range: 5%-85%, n = 3) for payment and 36% (n = 9) of the participants regularly treated underserved populations outside of their regular practice settings. Impact evaluation revealed 68% (n = 17) participants reported the DentPath Program had no impact on their practice location.

CONCLUSIONS

Future research is needed to determine methods to promote the transition of DentPath students through dental school and into underserved communities.

Defining Rural: The Predictive Value of Medical School Applicants' Rural Characteristics on Intent to Practice in a Rural Community

PURPOSE

To understand the predictive value of medical student application characteristics on rural practice intent.

METHOD

The authors constructed a linked database of 2012-2017 medical school matriculants from American Medical College Application Service applications and Association of American Medical Colleges Matriculating Student Questionnaire (MSQ, 2012-2017) and Graduation Questionnaire (GQ, 2016-2018). Using logistic regression, they compared application variables (birth, high school, childhood county, and self-declared geographical origin) to students' MSQ and GQ intent to practice rurally. Rural practice intent from matriculation to graduation was compared using the McNemar test for paired nominal data.

RESULTS

The number of students meeting inclusion criteria was 115,027. More students self-declared rural origin (18,662; 16.4%) than were identified using geographically coded variables (6,097-8,784; 6.1%-8.1%). Geographically coded rural variables were all strongly and similarly associated with rural practice intent, with rural high school being the most predictive on both MSQ (odds ratio [OR], 6.51; CI, 6.1-7.0) and GQ (OR, 5.4; CI, 4.9-6.0). Self-declared geographical origin was associated with a similar rural practice intent on both MSQ (OR, 6.93; CI, 6.5-7.3) and GQ (OR, 5.69; CI, 5.2-6.2). Rural practice intent declined for all groups from matriculation to graduation.

CONCLUSIONS

Considering students who self-declare as rural identifies a larger group of rural medical school applicants than more "objective" geographic variables, without negatively impacting students' predicted interest in eventual rural practice. Further research should track actual practice location and explore strategies to mitigate declining rural career interest.

Dental Students' Intent to Practice in Rural Communities Before and After Community-Based Rotations in a Rural Area

Community-based dental education (CBDE) has the potential to positively impact the educational process in a manner that both contributes to educational outcomes and shapes the learner's behavior. The aim of this study was to determine the correlation between dental students' intended practice location and the size of their hometown and to assess any impact their CBDE rotation in a rural location had on practice location intention. From March 7, 2016, to August 12, 2018, fourth-year students at one U.S. dental school were invited to complete a ten-item questionnaire prior to and after their four-week clinical rotations at a rural clinic. Of the 123 dental students on rotation at the clinic during this time, 106 completed the pre-rotation survey and 112 the post-rotation survey, for response rates of 86% and 91%, respectively. Prior to the rotation, 58.6% selected one of the rural locations as an ideal practice location, and that percentage increased slightly to 61.4% after the rotation; the difference was not statistically significant (p=0.984). The results did show a significant increase from pre to post rotation for women intending to practice in rural communities (p=0.0413). This study found that students' intent to practice in a rural location was not significantly affected by a clinical rotation in a rural clinic; however, there was strong evidence that students from rural communities intended to practice in rural communities after graduation.

University-based initiatives towards better access to oral health care for rural and remote populations: A scoping review

This scoping review maps a wide array of literature to identify academic programs that have been developed to enhance oral health care for rural and remote populations and to provide an overview of their outcomes. Arksey and O'Malley's 5-stage scoping review framework has steered this review. We conducted a literature search with defined eligibility criteria through electronic databases, websites of academic records, professional and rural oral health care organizations as well as grey literature spanning the time interval from the late 1960s to May 2017. The charted data was classified, analyzed and reported using a thematic approach. A total of 72 citations (67 publications and seven websites) were selected for the final review. The review identified 62 universities with program initiatives towards improving access to oral health care in rural and remote communities. These initiatives were classified into three categories: training and education of dental and allied health students and professionals, education and training of rural and remote community members and oral health care services. The programs were successful in terms of dental students' positive perception about rural practice and their enhanced competencies, students' increased adoption of rural practices, non-dental health care providers' improved oral health knowledge and self-efficacy, rural oral health and oral health services' improvement, as well as cost-effectiveness compared to other strategies. The results of our review suggest that these innovative programs were effective in improving access to oral health care in rural and remote regions and may serve as models for other academic institutions that have not yet implemented such programs.

Filling the Gaps: Predicting Physician Assistant Students' Interest in Practicing in Medically Underserved Areas

PURPOSE

Physician assistants (PAs) are well situated to provide much-needed care in medically underserved areas (MUAs). Therefore, it is critical to understand the factors that make PA students want to practice in MUAs. The current study investigated how 3 student characteristics-underrepresented minority (URM) status, geographic origin, and family socioeconomic status-were associated with PA students' interest in practicing in MUAs after graduation.

METHODS

Upon their matriculation in 2016, 4329 PA students provided key demographic information (ie, gender, age, race, ethnicity, geographic origin, and an indicator of family socioeconomic status) and reported their interest in working in an MUA after graduation. Multiple linear regression was used to predict students' level of interest in practicing in an MUA, and multiple logistic regression was used to predict students' likelihood of expressing interest in practicing in an MUA. All analyses controlled for students' gender and age at matriculation.

RESULTS

All 3 student characteristics were independently associated with interest in practicing in an MUA, such that URM students, students from rural backgrounds, and less affluent students expressed greater interest in practicing in an MUA after graduation compared with their non-URM, suburban, and more affluent counterparts.

CONCLUSION

Demographic commonalities may drive PA students' interest in practicing in an MUA after graduation.

Influence of Community-Based Dental Education on Practice Choice: Preliminary Data from East Carolina University

Maldistribution of the dental workforce contributes to poor access to oral health care. Community-based dental education (CBDE) may help to address this problem by using experiential learning to encourage new dentists to practice in underserved areas. The East Carolina University School of Dental Medicine (East Carolina University SoDM) employs a multifaceted strategy, including CBDE, to increase the number of dentists practicing in underserved areas of North Carolina. The aim of this study was to assess the influence of CBDE and other factors on practice choice among East Carolina University SoDM graduates. This cross-sectional study assessed practice intentions before and after a senior-year CBDE experience. Data were obtained for students in three graduating years from written student reflections and self-reported practice plans solicited at graduation. Of the total 156 students between 2015 and 2017 (52 each year), all students participated in at least one component of this evaluation: all students (100%) completed required student reflections, and 148 (95%) provided pre-graduation practice plans. Data were also obtained on alumni practice characteristics via a survey of recent graduates; 72 alumni (46% response rate) participated in the alumni survey. The assessments found positive attitudes towards the CBDE program before and after participation, although areas for improvement relating to business management and financial viability were reported. The majority of alumni respondents (67%) remained in the state to practice after graduation, with half reporting practicing in rural areas. For most alumni respondents (>75%), debt, salary, benefits, type of patient population, and desire to own/run a business were important factors other than the CBDE program influencing their practice choice. Nearly half of them (45.8%) rated desire to work in a public health setting as an important factor. This study provides preliminary evidence of the effectiveness of this educational model in retaining new dentists within the state to address the critical shortage of dentists in North Carolina.

Dental and Dental Therapy Students' Perspectives on How to Build Interest in and Commitment to Rural Dentistry

Few dental graduates are choosing to practice in rural areas, thereby aggravating the shortage of dentists in rural communities. The aim of this study was to identify factors that may motivate dental and dental therapy students to commit to rural practice. This qualitative study used a triangulation of data sources: students' reflection papers on their rural community experience, transcripts of focus groups with students, and personal statements submitted by three cohorts of student participants in a rural dentistry program in a U.S. dental school in 2016, 2017, and 2018. Common themes emerged in each data source, and a congruence of themes from the three data sources was identified: corrected misconceptions of rural dental practice, the gravity of lack of access to care, quality of relationships between practitioners and patients and within the dental team, and the role of dentists in alleviating health disparities. Students cited the critical role dentists play in stimulating interest to consider dentistry as a career and in inspiring rural practice after graduation. Immersion in a rural community under the mentorship of a rural dentist may correct misconceptions and attract students to rural practice. This study's results suggest that dental schools need to provide students with more opportunities to witness the practice of rural dentists and experience rural living in order to draw them towards rural practice after graduation.