Students trained in community-based settings, rather than solely dental school clinics, are exposed to the challenges and rewards of treating underserved populations. In order to deliver cross-cultural care, students need special preparation in cultural awareness, communication skills, and the social and behavioral sciences.

Dental students need to understand the economic, educational, social and cultural backgrounds of patients who may be working poor, unemployed, elderly, disabled, immigrants or incarcerated. They must develop communications skills based on empathy, curiosity, intellectual flexibility, highlighted awareness, and willingness to respect, listen and learn from the patient.

To develop these skills, University of North Carolina uses simulated patients and videotapes student interactions for analysis by students and instructors. Students are encouraged to be mindful of their experiences and reflect on issues, feelings and their own reactions to patients whose backgrounds may be very different than their own. They write short reports about their most moving encounters during a week, and longer first-person narratives about their community experience. They also create photographic scrapbooks and attend post-rotational seminars.

In this article appearing in a special issue of the Journal of Dental Education, the authors indicates that as a result of the Dental Pipeline program, the average amount of time dental students spent in community rotation increased from 40 days to 59 days. Students reported increased confidence and interest in treating underserved patients.