Connecting Education to Communities: Community Dental Rotations at the OHSU School of Dentistry

Mike Plunkett, DDS, MPH

Last summer many of you read about students from the School of Dentistry completing clinical rotations in rural communities.  Since that time we have strengthened our program's framework and developed a clearer vision for the future.  That being said, in this article I would like to provide a more formal description of community-based education, our program at OHSU, and our goals for the future.

Background

According to the 2007 Oregon Smile Survey 35% of Oregon children in 1^st through 3^rd grade have untreated tooth decay, and 63% have experienced tooth decay either treated or untreated.  Moreover, Oregon children's oral health is poorer than neighboring states of Washington, California, Idaho and Alaska.  The statistics are not much better for elderly citizens, especially those living on a fixed income in geographically underserved areas.   The Smile Survey also reported that approximately half of Oregon's dentists practice in the Portland Metro area, a trend that shows no sign of reversing in the short term. 

Most can agree that if these issues are left unaddressed the situation will only worsen.  The OHSU School of Dentistry is deeply concerned about access to care and development of the future workforce.  Consequently, one way that we are addressing these issues is by developing a statewide community-based dental rotation program.   

By extending the walls of the dental school throughout Oregon, we not only tap into a wealth of diverse clinical experience but also get directly involved in helping communities address their most pressing problems with access to dental care.  The School of Dentistry is also deeply concerned with the current and projected shortage of rural dental practitioners.  Consequently, our relationships with individual communities throughout Oregon will create a mutually beneficial pipeline, which paves the way for future programs aimed at increasing the number of practitioners in geographic areas most negatively affected by workforce disparities.

Community-Based Dental Education at a Glance

Community-based education has been established as a valuable educational method for nurturing a sense of community responsibility in health professions students, as well as a successful means of introducing students to a diversity of practice settings.  This model has been successful at many dental and medical schools in the U.S. and around the world.  For example, dental schools at Ohio State, the University of Kentucky, and the University of North Carolina require a minimum of 60-days of community-based clinical education.  The University of Colorado requires 100 days, and the University of Michigan is considering utilizing community-based sites for the bulk of the fourth year of dental education.  The states that are on the forefront of addressing workforce and access to dental care issues typically have a strong partner in their respective schools of dentistry.

Community-Based Education at OHSU SOD

Like many of the most successful programs around the country, our approach is grounded in strong partnerships with affiliated communities.  As director of the program I have personally visited 18 potential practice sites in 13 Oregon communities over the past 20 months.  These visits have led to the establishment of 13 legal affiliations and over 25 volunteer faculty appointments.  Other important partnerships include civic groups, foundations, and state organizations that deal with Oregon's most pressing health and education issues.

More than 20 students have completed "pilot" rotations.  During these rotations students provided approximately 40 weeks of clinical care in 11 Oregon communities. 

Beginning Fall term 2009, all OHSU 4^th year dental students will be given the opportunity to complete a 2-week community experience.  The rotations will span the entire senior academic year, and students will be extended credit for time spent in the community.  The majority of the students' time will be spent treating patients in a variety of community health centers and rural private dental practices under the direct supervision of an OHSU-affiliated volunteer clinical faculty.  While on rotation, students will also participate in activities conducted by other OHSU community partners.  Examples of such activities include direct involvement in practice-based research, school-based preventive and educational programs, and oral health policy advocacy to state and local elected officials or regulatory bodies.

As part of the curriculum, each student will complete a personal and professional development report which provides an opportunity for reflection on the impact of the community-based experience.These reports will lay the foundation for the student's life-time professional development, commitment to service and community collaboration, and ensure awareness of the comprehensive and complex nature of health care for vulnerable populations. 

To assess the impact on the community, OHSU School of Dentistry will monitor and analyze patient interactions. Such data will include number of patients treated, procedures performed, and constructive feedback from on-site clinical faculty.

Vision for the future

Our vision is both logistic and philosophical.  Logistically we will continue to establish community partnerships, evolve our curriculum, and provide students with increased experiences throughout Oregon.   Philosophically we will strive to make OHSU School of Dentistry a strong partner and invaluable community resource to the state.  Going forward we will not only continue our history of promoting clinical excellence but also play a strong role in assisting communities as they face the challenge of replacing an aging oral health workforce  and providing affordable access to dental care for all Oregonians.

Dr. Plunkett is an Assistant Professor in the Department of Community Dentistry and
Director of Community Dental Rotations at
Oregon Health & Sciences University School of Dentistry. He can be reached at
503-494-8830 or by email at plunkett@ohsu.edu