by Jay Boller and Claudia Kanter
Historically, Minnesota has been one of the least diverse states in the nation. Recently, that profile has changed. The average age of people in many rural communities is increasing, and both rural and urban centers are becoming more ethnically diverse.
Minnesota is now home to some of the largest communities of Somali, Hmong and Liberians in the U.S. The majority of these communities are located in the metropolitan area, but many rural areas have also been transformed by an influx of international newcomers who fill jobs in agriculture, and in meat and poultry processing. Rural communities also contend with an out-migration of young people and the subsequent ‘rapid aging’ of the remaining population.
According to recently retired State Demographer Tom Gillaspy, “It’s important to understand what we look like as a state and to determine how that translates into public policy.” Demographic research, he says, sheds light on state issues as diverse as health care for an aging population, rural population change, and changing state workforce and education trends.
He also notes that this decade alone will add more people over 65 than the last four decades combined. Nonwhite citizens are expected to represent 25 percent of the population by 2035.
Coupled with statistics that document an aging dentist population, these projections pose workforce challenges to the University of Minnesota, its dental school, and to the dental profession.
The Future is Now
The reality is that many Minnesotans already find it difficult to access oral health care. Some say it’s the result of a shortage of dentists, while others point to a maldistribution of dental professionals throughout the state. Still others fault a mix of regulatory, social, economic, educational, cultural and demographic hurdles. In reality, it is all of these, and more.
For the last eight years, the School of Dentistry has moved forward with a series of strategic initiatives designed to address dental access challenges. The underlying approach involves both providing care for patients in underserved communities and adapting dental education in response to workforce needs and changes in the dental care delivery system.
Access initiatives include new education programs and admissions policies, such as the Early Decision Rural Dentistry Track Program for students who plan to practice in rural communities.
Class sizes have also increased––by 33% (from 80 graduates in 2004 to 104 in 2011). Most of these new dentists have gone through the standard four-year program, but some graduate from a unique program for internationally educated dentists that prepares them for U.S. licensure in two years, thus expediting their entry into the dental workforce. Another new program––for dental therapists––will enhance the capacity of the existing network of providers to treat more underserved patients.
Curriculum changes also target access challenges. Students are now required to spend six to eight weeks treating patients under faculty supervision at one of the school’s seven outreach sites located in underserved communities throughout the state. Two of these dental clinics––at Rice Memorial Hospital in Willmar and at the Native American Community Clinic in South Minneapolis––are new within the last five years, the result of partnerships between the school, the University and community groups. Other such partnerships resulted in a new pediatric dental clinic and a clinic for special needs patients; both are hospital-based and staffed by faculty and by residents enrolled in advanced education programs in dentistry.
Recently, the school launched another initiative to meet the changing workforce needs of the state.
Destination Dental School
In 2010, the school rolled-out Building Bridges to a Dental Career, and the program is attracting national attention.
Funded by a $1.9 million federal grant from the Health Resources and Services Administration (HRSA), Building Bridges partners the School of Dentistry with the Minneapolis Public Schools and the Minnesota Urban Health Education Center for a common end goal: to enhance access to care by increasing the number of students from rural and underrepresented communities who will 1) consider dental careers; 2) be competitive dental school applicants; and 3) be successful in their dental school experience.
The program leverages the experience of the school’s Outreach Program, which has, for years, sent students to underserved communities to treat patients. The program helps address the immediate need of patients for dental care; it also has a longer-term impact.
“We know from experience that students introduced to life and practice in underserved communities as part of their education program are more likely to consider these practice locations after graduation,” says Naty Lopez, who is the principal investigator on the HRSA grant, the Building Bridges program director and assistant dean of admissions and diversity for the School of Dentistry.
“Research also shows that students who are recruited into dental school from underserved and under-represented geographic and ethnic communities are likely to have similar practice interests,” she says.
According to Lopez, Building Bridges assists qualified students from these communities to have the academic and life experiences that will help them be competitive in the dental school application process and successful in dental school. “We want to educate them and send them back to their communities to practice,” she says.
The program, though, is hardly a handout. In reality, it is a demanding, comprehensive approach that will help meet the changing workforce needs of the state.
The program includes initiatives for high school students, current college students, dental school applicants, and incoming dental students.
Building Bridges chart
The first arm of the Building Bridges Program is called Saturday Academy. Created for high school students from underserved communities, Saturday Academy intervenes early in the education process to encourage science-based careers and an interest in dentistry.
Now in its second year, the program requires that participants spend 20 days at the University of Minnesota in classes taught by University faculty, staff and dental students. A kick-off event, attended by proud, picture-taking parents and family members, featured welcoming comments from the dental school dean, a representative of the Minneapolis Public Schools and a White Coat Ceremony. Says Lopez, “The event sets the stage for what’s to come; we want students to begin to think of themselves as future professionals from day one.”
Each session includes six hours of structured learning activities, filled with lessons in everyday physics, chemistry and math. There are hands-on dentistry activities––taking impressions of teeth, removing plaque from dentoforms, learning about tooth numbering, and even an oral screening session with the student’s parent sitting in as the ‘patient’. Participants also are matched in a dental shadowing experience with School of Dentistry alumni who have dental practices in the Minneapolis area.
“The program opens doors for a lot of minority students,” said Ahmed Ahmed, program participant and junior at Heritage Academy High School in Minneapolis. “At first, I thought it was hard to become a dentist. Then I found out through the activities and exercises at each session that it’s not that intimidating.”
Such sentiment is exactly the takeaway that Lopez was aiming for: Making sure that young students know that science is an interesting part of their everyday lives, and that post-secondary education is within their reach. “If you don’t build math and science skills in high school, students aren’t going to pursue science courses in college,” she says. “And if they don’t take science courses in college, they’re never going to become a dentist.”
The Building Bridges program is designed to address this challenge. And the system is working, too. Ten of the first 14 high school program participants have their academic sights set on college…and dental school.
“The Saturday Academy experience is transformational,” says Peg Purdy, adjunct associate professor in the Department of Restorative Sciences and an Academy faculty member. “These students have the interest and the potential to succeed in college and beyond. After just a few weeks in the program, you can actually see a physical change…in the way they carry themselves, the way they sit. They begin to see the potential in themselves,” she says. Lopez is quick to add that the academy wouldn’t be possible if it wasn’t for the cross collaboration between the students, their high schools and parents, as well as the School of Dentistry and the University.
For Ahmed Ahmed, the program instilled a confidence that he hopes will eventually lead him to the U of M’s School of Dentistry.
“I hope to major in biology at the University of Minnesota,” he said. “If I do well in school and on the dental admission test (DAT), then I hope to spend the next four years in dental school.”
Summer Dental School Experience for Current College Undergrads
A second initiative of the Building Bridges Program focuses on current college undergrads who have expressed an interest in applying to dental school.
Through an intensive six-week Summer Dental School Experience program, students participate in 174 hours of structured learning experiences that include sessions to develop psychomotor skills and an understanding of life during dental school, exposure to prerequisite courses, a Dental Admissions Test review, and a health disparities research experience. Workshops hone stress management and study skills that all college students need to know.
Participants also visit community centers to learn about oral healthcare through the lens of underserved communities. The program ends with a poster presentation in front of the entire dental school––a community the participating students aspire to soon join.
All students are encouraged to apply for the Summer Dental School Experience, although first consideration for acceptance is given to students of underrepresented communities, such as rural areas, minority groups, first generation college students, and those who are economically disadvantaged.
The grant provides a $40 stipend for each day of class attendance, which may be used for miscellaneous expenses such as gas, parking and lunch. “Students make a significant commitment to the program,” says Lopez, noting that participation cuts into time that might be used for summer jobs and other student experiences. “One of our pre-dent students gave up a study abroad experience so that he could stay in Minnesota to take part in the summer dental school program.”
Post Baccalaureate Program
A third arm of the Building Bridges Program, called the Post Baccalaureate Program, is designed for students who applied to dental school but, for some reason, did not gain initial acceptance.
“The dental school application process is very competitive,” says Lopez. “And with 1,000 applicants for 98 positions in each class, there are always well qualified students who are not accepted. We’ve always been happy to meet with applicants who express an interest in re-applying.”
Typically, those meetings included a review of a candidate’s application materials and suggestions about how he/she can be more competitive. The Post Baccalaureate Program enhances and formalizes that experience into one that stretches an entire academic year.
Students in the Post Baccalaureate Program take courses at the University, including upper level General Chemistry, General Biology, Physics, Organic Chemistry, Biochemistry, Math and English. The program also includes sessions in life and learning skills, and meetings with course directors, tutors, etc.
If participants receive a 3.6 grade point average (GPA) and have qualifying DAT scores, they will be admitted to dental school. A number of students have already taken advantage of the program. Often, these applicants have worked fulltime through an undergraduate degree. Sometimes they have families; sometimes they’re older-than-average students looking for a career change.
Lopez is quick to note that distractions like full-time jobs and families, combined with a full course load, is challenging for any student. “One of the first things we do is recommend that these aspiring dental students drop their outside work commitments and concentrate on studying. For many, that makes for a high risk experience. The program has admitted students straight out of first-careers as diverse as engineering, dental assisting and accounting. “They have to give up good paying jobs to participate,” says Lopez, “so you know that dental school is something they really want.”
The grant does provide participants a monthly stipend, but students are responsible for all University tuition and fees, and living expenses. For these promising individuals, the Post-Baccalaureate Program allows them to be in school full-time. “It’s not easy,” Lopez says, referencing requirements like a 3.6 GPA, shadowing programs and volunteer work. “But the program allows students to take advantage of all of the resources that are available to them.” So far, it seems to be working. Of the six students in the inaugural class, all are ‘A’ students.
The final Building Bridges Program initiative is called the Pre-Matriculation Program. Open to every incoming dental student, it’s designed as a buffer before full-time dental school students who earned a place in the program. But maybe they’re new to the Twin Cities, or took their undergraduate program at a smaller school. The four-week program features mini-sessions that give students a feel for what their courses will be like and a general preview of college life in the Twin Cities.
Says Lopez, “We want every student accepted to dental school to succeed. But dental school and the Twin Cities can be an adjustment. If students don’t make an easy transition in the beginning and are left behind, it’ll be more difficult for them to be successful in dental school.”
A Draw to the Dental School
With Building Bridges, the dental school isn’t just affording students from underserved rural and urban communities the opportunity to compete for a place in the first-year class of dental students. The school’s commitment to outreach and engagement is proving to be a draw to all students.
Michael Brooks––a Florida native who initially came to Minnesota for a football scholarship at Concordia––was drawn to the dental school because of its national clout and reputation, and the school’s focus on community outreach and service. Currently a third-year dental student, he’s assumed a leadership role in the inaugural Saturday Academy.
“The School of Dentistry is one of the state’s largest safety net clinics––we don’t restrict who we serve––we accept all patients” he said. “But we can’t care for every patient in every underserved community. We need to do a good job of educating dentists to care for all Minnesotans.”
Working with the teenagers on mathematics, writing, sciences and other core dental preparatory skills makes them better candidates when applying to college, Brooks says, calling the Saturday Academy sessions equally rewarding for him.
Last year, Brooks accepted an award from the American Dental Association on behalf of the School of Dentistry in recognition of his involvement in the Building Bridges program. That type of recognition only further motivates him to continue his activities in outreach to underserved communities.
“Being able to recruit students from rural and underserved areas to come to dental school so that they’ll pursue a career in dentistry is a huge challenge,” he said. “They’ll hopefully go back and work in their own communities. One of the challenges is showing someone the benefits of working in rural communities when they come from the city where social networks are already established.”
Just in the second year of its three-year funding, Building Bridges is already being viewed as a win for the dental school.
Through the program’s four-pronged approach to recruit and develop prospective dental students, the region’s various underrepresented populations are getting the chance to compete, learn and hopefully become dentists.
For Naty Lopez, the next challenge will be securing additional funding so that the program can extend into the foreseeable future.
In the meantime, she’s thrilled with the progress and with how the program has addressed a core problem: tapping and fostering local talent.
Says Lopez, “As a land grant institution, the University of Minnesota is responsible for meeting the workforce needs of the state. And as the only dental school in the state, we educate the next generation of dentists.” Building Bridges, she says, is an innovative program that, when added to the arsenal of other School of Dentistry initiatives, moves the school forward in a responsible manner toward meeting that goal.
“We are applying the resources and expertise of the University to address community needs,” she says, “and investing in our very talented pool of Minnesota students in a way that enhances our ability to care for all of our neighbors.” We’re not talking about relaxing the standards of excellence required to be accepted into dental school. But some students just need help in finding their way to dental school. And we’re helping them cross that bridge.”
(This story appeared in the Spring 2012 edition of Dentistry Magazine)