Racial and oral health equity in dental school curricula

Abstract

Objectives: The objective of this study was to assess the current efforts to move dental school curriculum beyond diversity and inclusion toward an anti-racism approach to racial equity. Methods: In this cross-sectional study, an electronic Qualtrics survey was sent to 67 Dental School Associate Deans/Deans of Academic Affairs and 15 Dental Public Health (DPH) Residency Program Directors. Survey topics included oral health equity, Critical Race Theory (CRT), racism and the physiologic impacts of racism on oral health. Descriptive statistics were used to demonstrate frequencies. Results: Overall response rate was 31.7% (DPH = 6, predoctoral Dental = 20). The majority of respondents that answered the question stated that the educational program offered instruction in oral health equity (96.2%), racism (75%), and the physiologic impacts of racism on oral health (83.3%). Only 17.4% of the respondents stated that the educational program offered instruction in CRT. The main barriers to providing the instruction was limited faculty trained in the topics to offer the instruction or there was limited time to offer additional content in the curriculum. Conclusions: Findings demonstrate that oral health equity, racism and the physiologic impacts of racism are being discussed in dental education to some extent, but there is limited instruction in CRT. More robust efforts are needed to ensure dental students and DPH residents are competent in providing anti-racist and unbiased health care; there should be an incorporation of anti-racism standards in the Commission on Dental Accreditation (CODA)'s predoctoral and Advanced Education Program standards. K E Y W O R D Santi-racism, commission on dental accreditation standards, dental education, health equity, oral health, public health dentistry

Professionalism and professional identity formation in dental students: Revisiting the professional role orientation inventory (PROI)

“…Recent PIF studies have enlightened our understanding across racial and ethnic identities of the contributions to PI antiracism and decolonized pedagogic frameworks have in the learning environment. 14,23,[34][35][36] This is of particular importance given this study's finding of lower Authority scores among Asian students. "A strong sense of Authority is seen in a person who believes their judgements and opinions ought to be respected" and more considered than others, also feeling "they know what's best for themselves and others in matters" of the profession and practice.…”

“…This is systemic racism and centuries‐old negative stigmatization of Black women's hair. Recent PIF studies have enlightened our understanding across racial and ethnic identities of the contributions to PI antiracism and decolonized pedagogic frameworks have in the learning environment 14,23,34–36 …”

From describing disparities to understanding why disparities exist: Anti‐racist methods to support dental public health research

“…Scholars may also build on the limited‐but‐developing scholarship of racism and oral health outcomes to address areas including: Procedure decision studies that assess how implicit bias and racism affects dental team members clinical decision‐making and subsequent patient‐ and population‐level health outcomes, for example, the management of self‐reported oral pain [21,22]; The effects of patient‐provider discordance or concordance on clinical decisions and outcomes, for example, self‐identification through an intersectionality framework [51]. Community studies that document how community members' experiences with racism, discrimination, and prejudice in everyday and health care settings impact decisions to utilize dental services [23,28]; Pedagogical studies to develop and evaluate the impacts of antiracist provider education on dental practice [52]; Workforce studies to identify and strengthen pathways to dental careers among minoritized students and to understand provider support for interventions that advance equity in oral health service delivery, for example, accepting patients with Medicaid dental benefits and supporting autonomy in oral health prevention specialists' practice; Policy studies to determine the relationships between structural racism and oral health policy interventions, for example, municipal water quality and fluoridation in historically redlined or minoritized neighborhoods [29,53]; and Intervention studies that address structural racism to improve patient outcomes and access to care. …”

Heightened vigilance and perceived discrimination in dental trainees’ readiness for clinical practice

“…The dual pandemics (COVID-19 and racial injustice) and the 2020 racial justice uprisings also created pressure within the field of dental education to recognize the historic and contemporary impacts of racism on health and society and to advance anti-racism efforts in dental education and practice. [5][6][7][8][9] Described as a public health crisis, racism is a fundamental cause of health disparities 10 and societal inequities. Particularly, robust literature illuminates the distribution of and, mechanisms through which racism whether institutionally (e.g., through policy decisions) or interpersonally (e.g., harmful treatment when better choices are available), deliberate or unintentional, impacts health.…”

“…The murders by police officers of unarmed Black Americans George Floyd in Minneapolis, Minnesota, and Breonna Taylor in Louisville, Kentucky, and, the racially motivated violence against Asian Americans amidst the COVID‐19 pandemic amplified awareness of the global impacts of racism. The dual pandemics (COVID‐19 and racial injustice) and the 2020 racial justice uprisings also created pressure within the field of dental education to recognize the historic and contemporary impacts of racism on health and society and to advance anti‐racism efforts in dental education and practice 5–9 …”