Introduction

Dental Schools Teach Philosophy of Service

Collette Knittel

Copyright 2002 Journal of the California Dental Association.

In a time when dental school graduates are grappling with mounting debts and substantial loans, it might seem that students would be reluctant to volunteer their time and services. According to the ADA’s 2000 Survey of Dental Graduates, 91 percent of students graduating in 1999 came out of dental school with educational debt, which averaged $141,660.

Despite the financial reality of completing dental school, both students and the five California campuses have stepped up their efforts in the area of community service, dedicating both time and resources to help underserved communities.

Some schools, such as Loma Linda University, require that students complete what they call "service learning" as part of their curriculum, while others, such as the University of the Pacific, host programs with a 100 percent student participation rate. Either way, dental students are on the move, climbing into mobile clinic vans, clamoring onto airplanes destined for foreign lands, and piling into cars headed for health fairs, thereby fueling a community service renaissance in California schools.

Theories as to why this new volunteer movement has taken hold range from a raised awareness to a sense of professional obligation. The surgeon general’s sobering Report on Oral Health in 2000 and the grim events of Sept. 11 have also brought to the forefront the importance of helping those in need.

"Sept. 11 affected everyone," said Fred Kasischke, DMin, assistant dean for Admissions and Service Learning at Loma Linda’s School of Dentistry. "People are realizing there’s more to life than making money."

There is a well-developed sense in the dental community that oral health care providers, as educated professionals, have an obligation to educate and serve others.

"The commitment dental schools are trying to cultivate among students is that part of the ethical requirement of being a professional entails caring for those in need, regardless of financial circumstances," said Charles Bertolami, DDS, DMedSc, dean of the School of Dentistry at the University of California in San Francisco. "The idea is that if you’re going to be part of a profession, you must profess something."

The following is a school-by-school update of what California’s five dental campuses are doing to help underserved groups and communities throughout the state and abroad.

Loma Linda University School of Dentistry

Loma Linda has a history of service-oriented learning and continues to be a leader in outreach programs for the less fortunate.

"The School of Dentistry intends its service learning program to provide concrete examples of how dentistry and dental hygiene can be, at its heart, an endeavor to serve people’s basic needs," Kasischke explained.

At Loma Linda, the dental hygiene student engages in a minimum of 30 hours and the dental student is involved in 120 hours of service over the course of their respective programs. Students have the option of satisfying this requirement in a number of ways, including school clinics, health fairs, and international trips.

There are a variety of clinics set up for those who wouldn’t otherwise receive dental care, including a fixed, five-chair clinic in Mecca, Calif., at a school with one of the poorest academic performance in the state. Weekly during the school year, teams from Loma Linda travel to Mecca’s Saul Martinez Elementary School, Victoria Elementary School in San Bernardino, and Lugonia Elementary School in Redlands to screen and treat schoolchildren. Once a year, they host a family day, during which parents and siblings of the children may visit the school and receive treatment. Loma Linda students also volunteer monthly at the Share Our Selves Clinic and at the Compassion Clinic twice each month. Clinic With a Heart is an annual event where the campus opens its doors to the community while students, faculty, and staff provide dental services, no questions asked. It is anticipated that a newly acquired mobile clinic van will aid in providing treatment to additional elementary schools and board and care facilities for the elderly.

The most popular among the service learning options at LLU are the two-week Students in Mission Service-affiliated trips that take place during the school’s academic breaks. Groups of students, faculty advisers, and LLU alumni travel abroad to work in various conditions -- ranging from rustic clinics to bare dirt -- and treat people who would otherwise have no access to dental treatment. Trips this year include Malawi, Fiji, the Gilbert Islands, Armenia, Yap, Nicaragua, Haiti, Papua New Guinea, El Salvador, Belize, the Ukraine, and Mexico.

According to Kasischke, one of the goals of sending students out on service-learning projects is to experience firsthand the problems associated with access to care and underserved populations.

"We are hoping that their volunteering will be a lifelong pattern," Kasischke said. "Or that they choose to practice in an area that needs service."

Eunice Hong, who is now in the orthodontic specialty program at LLU, recently returned from a trip to Armenia, where she helped provide dental care to children in an orphanage.

"I will never be the same again," Hong said upon returning. "I had no idea there was so much need and that, as a student with developing skills, I could help alleviate that need in the lives of so many little ones. It enabled me to discover why I was doing dentistry, and helped me refocus my efforts to be the best I could be."

Experiences such as Hong’s are not uncommon at Loma Linda, and they have some impressive numbers to illustrate their commitment to their motto, "Yes we care. Yes we can." From June 1, 2000, to May 31, 2001, 935 students took 216 different trips (local and abroad) and performed 10,338 procedures on 7,206 patients.

University of Southern California School of Dentistry

USC offers its students many opportunities, both within the curriculum and on a volunteer basis, to serve the diverse oral health needs of the surrounding communities. The USC Mobile Clinic has been in operation since 1965, when a member of the school’s oral surgery faculty and several dental students visited a remote site in Mexico to provide emergency dental care and information on prevention of dental disease. Over the years, the USC Mobile Clinic has moved closer to home and has narrowed its focus to treating schoolchildren. In its 36-year history, the clinic has provided dental care to 75,000 children from low-income families.

What was once a single van has turned into a mobile dental fleet. The program has expanded to include a 36-foot mobile coach and three 48-foot fifth-wheel trailers. During the 2000-01 school year, approximately 300 dental and dental hygiene students, under the supervision of Randall Niederkohr, DDS, clinic director, and Charles Hsieh, DDS, associate director, participated in the program along with students from UCLA and other California schools.

A collaboration between USC, QueensCare, the Everychild Foundation, and the Los Angeles Unified School District expanded USC’s mobile efforts this year. Student volunteers, under the supervision of Director Brian Kelleher, DDS, now bring free comprehensive dental care to schoolchildren in some of Los Angeles’ most disadvantaged neighborhoods.

Students at USC have also developed their own volunteer group called Doctors Out to Care. The program, now part of the school’s curriculum, was founded in 1993 by third-year dental student Adel Tawfilis, DDS, who is now an oral and maxillofacial surgeon in San Diego. First-year dental students visit second-graders at one of seven local elementary schools and teach a five-session series on the basics of oral health. At the end of the series, children are tested to see how much information they retained. During their four years of school, the dental students work with the same group of kids to give them annual oral screenings to assess whether the program has been beneficial.

In addition to several mobile and stationary clinics, USC students also spend their time on a variety of specialized programs. Weekly, they provide screenings and oral health care at the Hollenbeck Home, a retirement community located in the Boyle Heights area in downtown Los Angeles. Through the USC’s clinic at the Union Rescue Mission, students provide comprehensive care for inner-city homeless. Each year, students volunteer to provide oral screenings to developmentally disabled athletes in the Special Olympics Special Smile program. They also participate in a variety of health fairs and a sealant project, where more than 300 inner-city elementary school students receive dental sealants each year.

"USC has a long-standing commitment to volunteering in our local communities," said Roseann Mulligan, DDS, associate dean for Community Health Programs. "It’s part and parcel of the fabric of our educational philosophy. Recently, we have increased our focus to provide more experiences in caring for disadvantaged populations that are truly reflective of the cultural and economic diversity found in California."

Community service has become such an integral part of the educational experience that USC faculty and administrators are in the process of developing a study that will measure how beneficial these experiences are for students.

"We know that more than 11,000 were served by our programs last year and that our students are enthusiastic in their support of these projects," Mulligan said. "We are developing a service learning student evaluation to quantify the effects of these experiences."

The survey will follow students into their professional careers to determine whether they adopt a permanent philosophy of volunteerism and community service.

"We would like the outcome to be that once our students graduate they feel, as a health care provider, they have a responsibility to their community that reaches beyond the people who walk into their office," Mulligan said.

University of the Pacific School of Dentistry

Proudly reporting a 100 percent student participation rate in volunteer community service programs, UOP provides its students with a variety of opportunities in addition to their required clinical rotations. Most of these programs are organized and implemented through a student-run organization called Student Community Outreach for Public Education, or SCOPE. Started in 1993 by five visionary students and one faculty member, SCOPE is dedicated to oral health promotion to underserved groups.

"The SCOPE program offers our diverse student body a chance to become involved in the community and to get a sense of what it means to be a health care provider," said Chad Hicks-Beach, UOP Class of 2004 and SCOPE participant. "It’s an opportunity for student volunteers to use our knowledge and skills to provide care and instruction to those in need."

Students create and volunteer in events such as community health fairs, classroom presentations and screenings, senior health programs, and sealant days. During the 2000-01 school year, SCOPE placed more than 700 sealants, and screened and educated more than 800 adults, children, and elderly individuals. In addition, they visited 50 classrooms or agency programs to provide health education lectures.

"Imagine expanding your experience and understanding of diverse, underserved community groups while being mentored and inspired by faculty, fellow upper-class students and alumni," said SCOPE President Jules DiGurno. "It’s a dynamic mentor-model."

In March of 2002, former SCOPE President Michelle Feliciano-Turner showcased the program and accepted an award at the American Dental Education Association’s Quest for Excellence in Dental Education Symposium in San Diego. SCOPE was judged to be one of the most distinctive and exciting examples of excellence in student-led community service projects among the 55 U.S. dental schools.

Class of 2001 SCOPE President Michael French noted that the SCOPE program has evolved continuously and prepares to celebrate its 10th anniversary in 2003.

"This innovative student service model motivates students to expand service to the community beyond a ‘dental’ focus as students volunteer for programs such as Habitat for Humanity, Hands-on San Francisco, and Mission District Food Drives," French said. "If a student can experience giving back to the community prior to graduation, then they are prepared to carry on with that service in their professional life."

Another significant community-oriented program put together by UOP and supported by the California Endowment is a $2 million grant project that creates and places "dental social workers" in regional centers throughout the state to serve as an intake and referral resource for people with disabilities.

"In collaboration with these centers, we continue to expand the development of community resources and to mount a statewide effort to improve access to local dental services for people with disabilities," noted Christine Miller, RDH, MHS, MA, associate professor and director of Community Programs.

Additional objectives of this community-based model are to train and support local dental professionals, continue a Statewide Task Force on Oral Health for Persons with Special Needs, expand the Dentist Training and Dental Hygiene Educators projects, and promote the Adopt-a-Home program throughout California. The goal is to promote system-wide, long-term solutions to oral health barriers for people of all ages with disabilities.

UCLA School of Dentistry

Like Loma Linda, UCLA also makes service learning part of the academic curriculum. To graduate, students must take an eight-hour elective service credit, though there are a variety of options that will satisfy the course. UCLA students often join the students at USC on their mobile clinic trips, where they travel on weekends, and sometimes stay overnight.

"When they stay in the community, students get a true sense of what it’s like," said Karen Lefever, PhD, academic coordinator. "They get together and discuss it afterward and try to understand the experience."

In addition to the mobile clinic trips, UCLA students often go out into different ethnic communities and provide oral health care at neighborhood clinics. The Salvation Army also has a clinic in downtown Los Angeles where students provide preventive and restorative care and screenings. Every Thanksgiving, students volunteer at a screening at the Santa Monica Civic Center. While homeless people are gathered at the center, students pass out toothbrushes, toothpaste, and floss, and perform oral screenings. First-year dental students can get involved by bringing along models and demonstrating the proper way to brush and floss.

"The impetus for many of these programs comes from the students," Lefever said. "It is a student-driven movement. It has really been a delight to see how excited and enthused students are about helping others."

Local community health fairs are also a popular credit option for students, as all levels can participate. Students further along in their schooling can accompany a UCLA-based group on their travels to Baja to help perform oral surgery at a clinic in Mexico, sponsored by Rotary International.

"Our hope is if they are supported in their efforts to volunteer as a student, they will continue to give back to their communities when they have practices of their own," Lefever explained.

University of California San Francisco School of Dentistry

With UOP and UCSF in proximity to each other, the San Francisco community receives a double dose of oral health services. In addition to requiring clinic rotations at San Francisco General Hospital in the low-income Mission District, UCSF encourages students to serve in community clinics located in rural areas that stretch from Tehama County to San Ysidro.

"Part of the reason underserved areas exist is because of geography," said Dean for Administration Julian Ponce. "Our hope is that when we send students into these rural clinics, they will have a chance to get to know the communities and the issues they face, and that they will consider practicing in an underserved area."

The off-site student rotations facilitated by affiliation agreements with federally funded and community clinics are an important outreach effort at UCSF. The school currently provides care to underserved communities through Shasta Community Health Center in Redding, La Clinica de la Raza in Oakland, San Ysidro Health Center in San Ysidro, Red Bluff Community Dental Clinic in Tehama County, and the Bay Area Women’s and Children’s Center in San Francisco’s Tenderloin District. School officials are negotiating additional affiliation agreements with Dientes! Community Dental Clinic in Santa Cruz, the Restorative Dental and Dental Hygiene Clinic of Santa Rosa Community College in Santa Rosa, the Del Norte Community Clinics in Marysville, and the Alameda County Community Health Clinics in Alameda.

The most popular elective course at UCSF is one that allows students to take part in a clinic for the city’s homeless. Roughly 100 dental and dental hygiene students participate each year, visiting citywide shelters and conducting screenings and interviews for approximately 80 to 100 patients per month. Selected patients are transported to campus one night a week for operative care provided by students and supervised by volunteer faculty. Approximately 650 patients are screened per year and 240 procedures are provided at no charge.

UCSF is also in a unique position to offer skilled dental care to HIV-positive San Franciscans, having sites convenient to all neighborhoods of the city, an internationally renowned faculty, and students who are experienced in providing expert, sympathetic treatment to patients with HIV disease. The program is funded under a Title I Ryan White contract with the city of San Francisco to provide $434,000 per year for dental care to HIV-infected city residents.

"Students are, by nature, idealistic and empathetic," Ponce said. "We are working on adding access-to-care issues to our educational curriculum so students can learn about the state of general oral health in California and in our country."

By nature, the subject of education has always lent itself to a sense of commitment to helping the less fortunate. Former professor of English and dean of Barnard College in New York City Virginia Crocheron Gildersleeve wrote, in her 1954 book called Many a Good Crusade, "the ability to think straight, some knowledge of the past, some vision of the future, some skill to do useful service, some urge to fit that service into the well-being of the community -- these are the most vital things education must try to produce."

As access-to-care issues surface and further cuts to an already unstable health care system seem inevitable, the role of service learning becomes increasingly significant in California dental schools. Both students and faculty are making a collective effort to reach in and help out. They realize that, as our state continues to grow and change, the role of the oral health professional must also evolve to meet the needs of the state’s residents.

"The dental profession cannot be isolated from the changes in demographics affecting the entire state," UCSF’s Bertolami said. "The dental schools’ curricula recognize this and have adapted to it."

Author

Collette Knittel is CDA’s staff writer. She can be reached at collette@cda.org.