Framework for Evaluating The RWJF Dental Pipeline Initiative to Improve Access to Dental Care

The Program Being Evaluated

Launched in 2001, the Pipeline, Profession & Practice: Community-Based Dental Education (Dental Pipeline) program is a five-year program designed to help increase access to dental care for underserved populations. In Round 1 of the program, the Robert Wood Johnson Foundation (RWJF) and The California Endowment funded 15 U.S. dental schools to develop community-based clinical education programs for a period of five years. Round 2 began in March 2008, awarding eight more dental schools funds to carry out similar programs. These programs provide care to the most vulnerable populations and increase recruitment and retention of low-income and underrepresented minority students.

With the funding from the Dental Pipeline program, dental schools are required to:

  • Establish community-based clinical education programs;
  • Revise didactic and clinical curricula to integrate community-based practice experiences into their educational programs; and
  • Implement programs to increase recruitment and retention of underrepresented minority and low-income students

About the Evaluation

Led by Ronald Andersen, Ph.D. from the University of California, Los Angeles, the major evaluation questions concerned: recruitment of underrepresented groups, curriculum revision, clinical services to the underserved, the decision to practice in settings serving disadvantaged population, and sustainability.

Summary of Methods

Incorporated data triangulation, or the use of multiple methods of data collection used to offset potential bias and measurement error, the methods included:

  • Sites visits during each of the three phases;
  • implementation, financial and annual feedback to the sites, the Foundation and the NPO;
  • analysis of American Dental Education (ADEA) and American Dental Association (ADA) surveys of all accredited dental schools;
  • two surveys of faculty in 14 of the Pipeline schools;
  • syllabi collection and case study; and
  • a survey of curriculum.

Knowledge and Impact

The cross-site comparison and multivariate analyses show the following:

  • Pipeline schools compared to non-Pipeline schools demonstrated significantly greater increases in the odds of underrepresented minority (URM) enrollment from 2003-2007, increasing 27 percent. This was achieved by addressing financial barriers through more scholarships, regional barriers, reconsideration of admissions criteria, and provision of role models.
  • All schools used the opportunity to enhance their community-based dental education and cultural competence curriculum. The evaluation showed that the program provided increased awareness of cultural issues and earlier entry into clinical patient care because of extramural clinical rotations. Administrative support and presence on the faculty of someone with behavioral or social science expertise were key facilitators of these changes. Barriers included inadequate faculty members to conduct small group seminars or other faculty-intensive methods of content delivery.
  • The average number of days in community rotations increased from 16 to 39, with four schools achieving the 60-day challenge goal. Critical to this process was the development of affiliate sites that could accept, teach and mentor the students. Faculty concerns over the quality of clinical training posed a barrier to this component, although there is no evidence that quality of training differed between community and conventional training sites. The evaluation identified novel adaptations to facilitate community-based training. Schools generally agreed that extramural rotations would be sustained.
  • Practice plans of senior dental students for community-based work were overall unchanged by the program. However, student perceptions of the adequacy of preparation for the extramural rotations were associated with their plans to provide care to at least 25% underserved patients. Student characteristics also were related to plans to provide care. Plans to provide care were also affected by student characteristics. The odds of providing care to underserved patients were over three times greater for URM students than for white students. Educational debt and lack of reimbursement for care to uninsured and publicly insured patients posed barriers to providing care to underserved patients.
  • Dental educators have followed the progress of this initiative with great interest. Deans and faculty leaders from other dental schools attended many meetings of the initiative, and it is likely that the momentum for change in dental education will continue. Areas of change included: financing of extramural rotations, regional enrollment cooperative, and reconsideration of student test scores as a criteria for acceptance. For further information, consult the Supplement to the ADEA Journal of Dental Education, February 2009, entitled “Evaluating the Dental Pipeline Program: Recruiting Minorities and Promoting Community-Based Dental Education.”