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Full Exposure

Fourth-year dental students participate in the UIC College of Dentistry’s externship program. (Photo by Lloyd Degrane)

The UIC College of Dentistry's award-winning community based education program provides fourth-year dental students with valuable clinical experience and teaches them a thing or two about the rewards of working in public-sector health care

 

By Steve Hendershot

Julie Arabia is trying to get her patient to talk. It isn’t easy—it never is, with a 7-year-old in a dentist’s chair—but she tries, asking first about the girl’s favorite subject in school, then about her brothers and sisters. Arabia receives mostly quiet, one-word responses, and seems resigned to start her examination when her patient suddenly blurts out, “I want to be a dentist!”

This is a breakthrough for Arabia, a fourth-year dental student who is serving an externship at Chicago’s Lawndale Christian Health Center as part of the UIC College of Dentistry’s Community Based Education program. She knows that LCHC dentists are exceptional at forging personal connections with their patients, even during short visits, and it is a trait she hopes to learn and emulate. So she forges ahead with this gift-wrapped opportunity, offering to answer questions about dentistry and saying, “We could use a dentist like you.”

The girl squirms as Arabia administers an anesthetic, using an understanding tone when she says, “I know—this is the worst part.” It’s only then that she asks why her patient is drawn to the profession.

The girl doesn’t hesitate: “It looks easy.”

Hmm. Arabia knows better, of course, but also senses that she’s been paid a high compliment. Indeed, the staff here makes dentistry look easy, even fun. Apparently, Arabia is learning the tricks of the trade. 

An introduction to the public health sector
CBE is unique and so successful that it helped earn the College of Dentistry the 2012 William J. Gies Award for innovative clinical curriculum from the Washington, D.C.-based American Dental Education Association. The award represents a decade’s work in developing and refining a clinical program that simultaneously provides top-notch dental education and dental care to underserved communities. CBE began in 2002 with a $1.5 million grant from the Robert Wood Johnson Foundation and has been a runaway success since its formal debut in 2005. In 2010, for example, fourth-year externship students saw 12,500 community-clinic patients.

LCHC is one of 17 CBE sites in Illinois, most of which are in the Chicago area. There also are sites in Colorado where students can work with migrant populations, as well as a few international options. The program experience centers on the Illinois sites, where students spend eight weeks rotating back and forth between campus and community—one week at a clinic, followed by one week on campus. Then the process repeats at a different site, until each student has completed a rotation at four or five locations. (Students are generally able to select the sites where they perform rotations.)

“The dental school environment is not a health system; it’s an education system,” says Dr. Caswell Evans, who heads CBE and serves as associate dean for prevention and public health sciences at the College. “So it’s important for our students to understand there are any number of opportunities to practice in different contexts based on the social and cultural needs of the patient population.” (In 2011, Evans himself received a Gies Award for achievement by a dental educator.)

According to Evans, one of the program’s greatest benefits is that it exposes dental students to prospective work environments other than private practice. Once students “have had experiences at these sites … different professional opportunities may be more attractive to them than their initial plans,” he says.

At some of the CBE sites, students work under staff dentists who are alumni of both the College and the program—and who have had career-altering externships themselves.

One of them is Dr. Lynse Briney, DDS ’05, CERT ’11 DENT, MS ’12 DENT, a member of the first class of CBE externs in 2005, whose work sites included the Children’s Clinic, a 95-year-old dental clinic in west-suburban Oak Park, sponsored by the Oak Park River Forest Infant Welfare Society. She has worked there part-time since 2006, in addition to running a private practice. Last fall, Briney became the oral health director for the Children’s Clinic, where she now spends two days a week.

The externship “gave me a taste, and I found it was a wonderful model and environment to practice in,” says Briney. “I knew I wanted to be involved.”

That experience isn’t uncommon, according to Dr. Jill Baskin, DDS ’83, who preceded Briney as the oral care director at the Children’s Clinic and served as its CBE site preceptor until 2013. “Students may start the rotation convinced they want to treat children in private practice, but my hope and experience is that that changes,” she says. “It allows students to see how they are able to incorporate public health into what they see as their private-practice future.”

UIC students who aren’t persuaded to pursue a career in underserved communities still make a difference as CBE externs. Baskin estimates that the Children’s Clinic provides 1,500 additional patient visits per year because of student participation; overall, the clinic sees about 6,000 patients annually. “It makes a huge impact,” she says.

For Briney, of course, the impact has been career-changing. And now she is able to share her knowledge with the dental students who rotate through the Children’s Clinic: “You see their confidence grow,” she says. “They have the opportunity to work with dental assistants and run the team, and you see them get comfortable walking into a practice that right away is challenging for them. To see that is an awesome experience for me.”

It was an externship at the Children’s Clinic that gave Dr. Justin Welke, ’11 DDS “a sense of accomplishment I hadn’t felt elsewhere,” he says. Now a pedia-tric resident at the University of Illinois Hospital, Welke says his experience at the clinic “is how I found my calling, because it opened my eyes to working with kids.

“When you step outside the four walls of the dental school building, you get a whole new perspective on the disparity that exists in a public-aid clinic,” he adds. “And you see that for us to help out is huge—it adds a ton to the community.”

A holistic approach to dentistry
LCHC debuted a new, state-of-the-art facility in Spring 2012, which stands in sharp relief to its surroundings in Lawndale, one of Chicago’s poorest neighborhoods. The new health center is an anchor of the area’s attempt at revitalization, and provides care to nearly 200,000 patients annually. About 8,000 of those are dental patients, a number that is likely to increase, thanks to the new building. LCHC’s dental clinic now has 18 chairs instead of three; 15 seats are dedicated to pediatric patients. The clinic is staffed by four full-time dentists and one part-time dentist, in addition to the CBE students who work there.

In contrast to the Children’s Clinic in Oak Park, faith-based LCHC doesn’t increase its patient capacity through the CBE program. Instead, LCHC Externship Director Dr. Edwin Mangram considers it an opportunity to provide students clinical experience and “show them a different perspective,” he says. “When I went to dental school, I never thought about working at a clinic where you show your faith through work. And here I’ve gotten a great response from students who have never seen that type of dentistry done. And that’s the goal—to share knowledge with the students so they can see a different part of dentistry.”

Mangram is likely to ask his young patients about their interests and aspirations, but it’s not just patter designed to get them comfortable. “You can have a 17-year-old who just wants a cleaning, but I want to know what I can do to change that child’s life,” he says. “If that’s a child who might be interested in [joining a] gang, I want to know about that, and hopefully give some kind of advice and wisdom to help them change their lives.”

And while the dentists at LCHC must move quickly from one patient to the next in order to accommodate as many as possible, Mangram has a knack for establishing a strong connection in a short period of time, and his constant laughter reverberates throughout the clinic.

“He’s like a little kid, laughing all the time and cracking jokes,” notes Alli Alberts, a UIC dental student from downstate Smithton. “He’s so welcoming.”

Classmate Sonia Shweiki ’09 LAS of Chicago’s Back-of-the-Yards neighborhood says Mangram “makes it feel like it’s not just a dental office, but a place where people will care about you and want to know about you.”

At Mangram’s request, Shweiki encourages her pediatric patients to plan on attending college. Thanks to her LCHC experience, she’s begun to think of patient care on two levels: the procedural and then the personal. The latter, she says, is to “see if you can make a difference in these kids’ lives.”

Dr. Grace Ahn, DDS ’07 found her LCHC externship experience so powerful that when she moved back to Chicago from California in January 2012, she visited the clinic to see her former mentor, Mangram. Soon, Ahn was its newest staff dentist and overseeing the UIC students doing their rotations at LCHC. Most of her conversations with them revolve around the technical aspects of dentistry, but every once in a while she offers career advice. “That’s kind of cool, because I certainly remember my experience here as a student, and were it not for that positive experience, I would not be back here,” Ahn says.

“It’s contagious for us,” Arabia says. “The best thing you can take out of this experience is to emulate Dr. Ahn and Dr. Mangram, because they want to be here, and you can tell that they care about the kids and adults that we see. Showing up to work every day can be a chore, but here it seems like they feel it’s their calling—that this is what they’re supposed to do, and they’re very happy and fulfilled doing it.”

Arabia, Alberts and Shweiki are working together on the LCHC rotation; last summer, they all participated in a six-week rotation at Salud Family Health Centers in Colorado. When Alberts entered the CBE program, she was planning a career in private practice, but has since reconsidered.

“We’ve been having a fantastic time at LCHC,” Alberts says. “It’s a beautiful setting. There are great people around, and you get to help the underserved. It has opened my eyes to see that maybe I can do this instead of private practice.”  

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