Student-run clinics offer real-world experience

Dental students are finding a taste of business management, community service and wet-gloved practice through dental clinics that they themselves manage.

The University of North Carolina at Chapel Hill School of Dentistry has one of the country’s oldest programs, known as the Student Health Action Coalition, which was founded in 1968 to bring dental care to underserved patient populations and get students involved in community service early in their careers.

At the University of Illinois at Chicago College of Dentistry, the founding of the first student chapter of the American Association of Public Health Dentistry in 2008 led to the expansion of a dental clinic at Goldie’s Place, a support center that teaches skills to homeless people who are adjusting to employment.

A group of community-minded students at the Columbia University College of Dental Medicine have launched a mobile dental clinic that enables them to provide dental care to patients in Harlem, N.Y. The initiative presents challenges related to supervision and funding, but the students have set an ambitious goal of providing care at least once every other week when school is in session.

Undergraduate students with dental career aspirations are also running clinics. Students in the University of California-San Diego Pre-Dental Society manage all aspects of the Student-Run Free Dental Clinic Project, with care provided by licensed dentists. The joys of volunteerism have been explored through several international volunteer missions led by Dr. Irvin Silverstein, director of the UCSD Pre-Dental Society and Free Dental Clinic Project.

The clinics are no small endeavor but it’s worth the time and effort, say organizers. The students can only provide dental services under faculty supervision, and in most cases, it is the students’ responsibility to recruit faculty for oversight.

But there are many benefits to the schools, the public and ultimately the profession as a whole, by providing another way to extend access to dental care to patients who have few or no other options, giving students a leg up on running a practice and developing a generation of service-oriented dentists.

“What we try to do is introduce students to career opportunities that are different than solo private practice,” said Dr. Caswell Evans, associate dean for prevention and public health services at the University of Illinois at Chicago College of Dentistry. “There are many populations that face challenges with access to care and many service sites that try to provide that access. We demonstrate ways that dentists can be involved either by volunteering or through employment, and Goldie’s Place is one way of doing that.”

“To my mind, this is real health care. These are patients that have no remunerative means other than a smile or a hug at the end of the visit,” said Dr. Allen Samuelson, clinical associate professor and director of special care dentistry at the University of North Carolina at Chapel Hill School of Dentistry, and a faculty advisor with the Student Health Action Coalition. “I’m convinced there are students who leave here and say, ‘I want to do that in my practice.’ ”

Student Health Action Coalition

UNC, which also has student-run programs in medicine and other health professional schools, says the SHAC clinic is the oldest continually operating student-run dental clinic serving indigent patients in the nation. For almost 20 years the clinic has operated out of the Orange County Health Department on three evenings a week. Examinations, hygiene care, oral cancer screening, extractions, restorations and education are all provided by students, and complex cases are referred to the dental school. Patients pay nothing for care.

Third-year student coordinators are the key to making it work, said Dr. Samuelson, by managing the clinical activities and recruiting volunteers, which includes faculty supervision. Without supervision, the clinic cannot operate. “It doesn’t happen very often but has happened before,” said Dr. Samuelson. “Unfortunately it’s on a volunteer basis only, so it can be difficult to find available faculty.”

Not in short supply are student volunteers, said third-year dental students and SHAC coordinators Steve Daniels and John Flynn.

“Word of mouth builds enthusiasm,” said Mr. Daniels, which could be applied to both patients and students.

“You might think it’s hard to find students to staff the clinic,” said Mr. Flynn. “But even after a long day followed by the SHAC clinic where you get out at 10 o’clock at night, they’re looking forward to coming back.”

Patient appreciation is the main reason students come back. “There are patients lined up hours before the doors even open,” said Mr. Daniels. “And so many are just beaming when they walk out the door, almost in tears from the pain relief. That’s the one thing that I never anticipated, how appreciative patients would be. It inspires you to want to do this beyond dental school.”

As coordinators, they do everything involved in running the clinic, said Mr. Flynn. “We do staffing for the people doing operative dentistry, we are the ones who create the schedule, we keep track of forms and documents that have to be completed, we talk to vendors who donate dental materials, we get materials and we look for funding.”

This year the coordinators developed an operations manual for the clinic to establish protocols, and they’ve begun moving the clinic’s focus from urgent care to a more preventive component. “We say, ‘Let’s make this the last filling you get done, or the last tooth you’re having pulled,’ ” said Dr. Samuelson. “We talk about brushing and emphasize the need to stop the disease process.”

SHAC is a great way for students to hone patient management and practice management skills, but the student coordinators also see it as a way to learn about oral health care disparities which could lead to more volunteerism. Another service initiative that Mr. Daniels has been involved with in recent years is the North Carolina’s Mission of Mercy program, and he plans to continue participating in the N.C. MOM after dental school.

Goldie’s Place

Dental services had been offered at Goldie’s Place in Chicago since 1997 when Dr. William Bjork, a UIC College of Dentistry graduate, took a personal interest in providing that care. In 2008, Dr. Caswell Evans and two student co-planners鈥攏ow Drs. Esther Lopez and Chernara Baker鈥攕et out to expand the clinic’s capabilities and make it entirely student run.

“Goldie’s helps homeless people get back on their feet, and one of their programs addresses job preparedness that is intended to move people into the job market,” said Dr. Lopez, who currently serves as the dental director of Goldie’s Place. “The first impression in an interview means a lot, and being able to smile and show their front teeth gives them confidence.”

Dr. Lopez writes grants and maintains the clinic policy manual, and does whatever else it takes to help students run the clinic, where she also volunteered as a dental student. The one thing she can’t do is supervise students performing dental work鈥擴IC requires supervisors to have been in practice at least two years.

Every Saturday under faculty supervision, a team of students staffs the dental clinic at Goldie’s, where extractions, restorations and even root canals are performed. Under the leadership of third- and fourth-year students, team captains appoint student volunteers to work the reception and sterilization rooms, and designate those who work as dental assistants and student dentists.

Third-year student Tariq Riyal said the students’ strengths are carefully evaluated in order to assign positions. For example, first-year dental students are prepared for sterilization and scheduling, while second-year students are able to assist with radiographs.

“We don’t get much training in running the business side of a practice while in dental school so this is a great experience,” said Mr. Riyal. “We’ve learned how to run an office, how to write grants and obtain funding, how to schedule patients and staff. It’s also a great way to learn how to practice efficiently, since we try to see at least 12 patients a day.”

Goldie’s also offers a stark contrast to the dental clinics at UIC, said Dr. Evans. “The first time students see the school clinic, they think it’s set up like magic,” he said. “They find out at Goldie’s that magic happens by hard work.”

Volunteering at Goldie’s Place as a student strengthened Dr. Lopez’s desire to practice public health dentistry, but that decision was made years ago when as a 12-year-old, her parents relied on her bilingual skills to help them navigate the health care system. She went to UIC, one of 15 dental schools in the Robert Wood Johnson Foundation’s Dental Pipeline Program that provided funds to dental schools to enroll additional underrepresented students and expand community-based care for low-income patients in the interest of reducing oral health care disparities.

“I knew I wanted to make a difference in the lives of people who need help so people don’t have to go through what my family did,” said Dr. Lopez. “It’s such an eye-opening experience to work with patients who have no way to access care, and that’s why I think it’s important to make sure this is a student-run model. Students really take pride in being able to serve these patients and work hard to recruit other students to serve the community, too. This is really good for the profession.”

Keeping it going, at least for now, are public-private partnerships between Goldie’s Place, which has budgeted modest funds for the dental clinic; the UIC College of Dentistry; and Henry Schein Cares, which donated equipment and supplies to expand the clinic in 2008. Area dental laboratories donate low-cost prostheses for patients.

M.S. Yuan Student Run Free Mobile Clinic

Identifying funding sources to support a mobile clinic launched by students at the Columbia University College of Dental Medicine in April of this year is always on the minds of organizers.

“The clinic is to help serve those individuals around New York City with limited access to care, including homeless and low socioeconomic populations in Harlem,” Patricia Hong, third-year student at Columbia and fundraising chair of the M.S. Yuan Student-Run Free Mobile Clinic, wrote to the ADA. “The responsibility rests upon our shoulders to be self-sufficient in every aspect. As students we are able to dedicate our time and service to these underserved populations, but we are in desperate need of much financial support and/or supplies. We are looking to collect any possible donations of instruments, supplies, materials and/or financial support to keep our van and services running year-round.”

Making dental care accessible for the neediest patients was what one of the organizers, Dr. Payam Afzali, a 2009 Columbia graduate, observed when he volunteered at the Student-Run Free Dental Clinic Project while taking predental classes at UCSD. Dr. Afzali and Columbia students formed a partnership with medical students who were already operating a free clinic in Harlem for homeless people to provide oral health screenings, then looked for ways to expand the clinic and offer more preventive and emergency care. The dental school has a mobile clinic that is fully equipped with X-ray and sterilization, and was willing to let the students use it if they could secure their own volunteers, funding and faculty supervision.

“We park the van outside St. Mary’s Church in West Harlem,” said Ms. Hong. “A community group that does outreach lets the people in the neighborhood know they can come to the church for food. We generally do restorative care, cleanings and simple extractions. Patients have a lot of needs, and are often between jobs and homes.”

“The most important aspect of the clinic is providing continuous care and creating trust in this vulnerable population,” said Dr. Afzali.

There have been obstacles since conducting the first M.S. Yuan Student-Run Free Mobile Clinic, like the need for a commercial driver’s license for the mobile unit (student Jeff Nichelini obtained one) and faculty supervision. Not only are faculty supervisors required for the clinic, but Columbia requires that they have an additional certification to provide oversight away from the school, which reduces the number of supervisors available. Dr. Afzali thanks Columbia faculty Dr. Stephen Marshall, director of the Dentcare Program, for his ongoing support, and Dr. Gregory Bunza, director of the GPR program, who has volunteered to provide supervision for students at the clinic. The goal is to have the clinic operate once a week or every two weeks, but only with faculty supervision.

Dr. Afzali likens the process of starting the clinic to putting together a puzzle. “There are so many resources out there, and it takes time and energy to put them all together,” he said. “If you use the resources and work as a collective group, you have the power to help so many patients who are in dire need.”

One problem they don’t have is getting students to volunteer to work at the mobile clinic. “I’m amazed how it’s working out because everyone has such busy schedules,” said Ms. Hong. “But somehow it all comes together.”