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University of Connecticut UCHC Graduate School Masters Theses University of Connecticut Health Center Graduate School 2009 The Dental School Applicant Pool and the Oral Healthcare
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University of Connecticut UCHC Graduate School Masters Theses University of Connecticut Health Center Graduate School 2009 The Dental School Applicant Pool and the Oral Healthcare Workforce Lauren Mentasti Consonni University of Connecticut Health Center Follow this and additional works at: Part of the Dentistry Commons, and the Public Health Commons Recommended Citation Consonni, Lauren Mentasti, The Dental School Applicant Pool and the Oral Healthcare Workforce (2009). UCHC Graduate School Masters Theses The Dental School Applicant Pool and the Oral Healthcare Workforce Lauren Mentasti Consonni B.S., University of Connecticut, 2005 A Thesis Submitted in Partial Fulfillment of the Requirement for the Degree of Master of Public Health at the University of Connecticut 2009 APPROVAL PAGE Master of Public Health Thesis The Dental School Applicant Pool and its Impact on the Oral Health Workforce Presented by: Lauren Mentasti Consonni Major Advisor Edward A. Thibodeau, D.M.D., Ph.D. Associate Advisor Tryfon Beazoglou, Ph.D. Associate Advisor Ardell Wilson, D.D.S., M.P.H. University of Connecticut 2009 i Acknowlegements I wish to thank Dr. Edward Thibodeau for his mentorship and guidance throughout our research endeavors and my scholastic career. Thanks also to Dr. Ardell Wilson and Dr. Tryfon Beazoglou for their constructive criticisms and encouragement during my Masters in Public Health Program. ii TABLE OF CONTENTS Executive Summary A. Preface 1 B. Introduction. 2 C. Published Works Characteristics of Dental School Feeder Institutions 2. Pre-Dental Enrichment Activities of U.S. Colleges and Universities 3. Nonacademic Characteristics of Dental School Applicants 4. Dental School Applicants by State Compared to Population and Dentist Workforce Distribution D. Conclusions.. 8 E. Epilogue Appendix A: Journal of Dental Education Publications.. 11 Appendix B: Reprint Permission and Copyright Notices. 39 References.. 40 iii Executive Summary A. Preface One of the major challenges faced by the dental profession today is the recruitment of the most qualified dental school applicants who are capable of serving the nation s future oral healthcare needs. The Association of Schools of Public Health (ASPH) 1 also recognizes this challenge, describing one of the three core functions of public health as assuring that all populations have access to appropriate and costeffective care, including health promotion and disease prevention services. To achieve this core function, the ASPH cites a competent public health and personal healthcare workforce as one of the ten essential public health services. Unfortunately, the goals of both quality and equality in terms of the dental workforce and access to oral healthcare have yet to be realized. When considering access to oral health services on a national or state level, a thoughtful and thorough consideration of the dental school applicant pool is essential. According to a recent study published in the Journal of the American Dental Association, the annual number of retiring dentists will exceed the number of newly licensed dental practitioners in 2009, a trend which is projected to continue throughout the next decade. 2 The approximately 4,400 dentists produced each year from the nation s 57 accredited dental education programs are charged with the responsibility of meeting the oral healthcare needs of the population at large. 3 1 B. Introduction The dental school applicant pool represents the future of the dental profession. An understanding of the dynamics of the dental workforce begins with an understanding of the undergraduate colleges and universities that are producing students interested in pursing dentistry as a career. An insight into the predental enrichment activities of such undergraduate institutions, as well as an understanding of the academic and nonacademic characteristics of dental school applicants is necessary, yet has not been well researched. This information may be useful for states or geographic regions interested in increasing the size of the dental workforce or for areas with the goal of maintaining an adequate number of oral healthcare providers. The relationship between the dental school applicant pool and the dental workforce is also poorly understood. The dental school applicants of today represent the oral health workforce of tomorrow. Although the number of dentists nationwide may be sufficient to meet the oral health demands of Americans, the workforce is not adequately distributed to serve the needs of the population. According to the United States Health Resources and Services Administration (HRSA), as of September 2008 there were a total of 4,048 areas designated as Dental Health Professional Shortage Areas (HPSAs) where there is less than one provider per 3,000 people. 4 A total of 48 million people live in these geographic Dental HSPAs, and a total of nearly 9,500 practitioners are needed to improve the status of these areas. In order to better understand the relationship between dental school applicants and the workforce four research projects were conducted. 5,6,7,8 These studies represent the first examination of undergraduate colleges and universities that supply applicants to 2 dental schools, as well as the first in-depth investigation into the characteristics of students interested in pursing dentistry as a career. Finally, an analysis and examination of the relationship between a state s dental school applicants, total population, and dental workforce distribution is the primary focus of the final article. This information provides the foundation for the development of future interventions aimed at addressing inadequacies in the distribution as well as demographics of the oral health workforce. C. Published Works 1. Characteristics of Dental School Feeder Institutions 5 The purpose of this study was to facilitate enrollment and recruitment strategies by identifying and characterizing feeder colleges and universities that are the major source of applicants to U.S. dental schools. Feeder school information was obtained from The Associated American Dental Schools Application Service (AADSAS) for the admissions cycle. The reports identified the degree status, institution and demographic information of each applicant. Feeder schools were defined as any school with 5 or more applicants. Minority-feeder schools were those with 2 or more applicants. Schools were ranked based on the total number of applicants (Category 1) and, to minimize the effects of school size, the applicant to total undergraduate enrollment ratio (Category 2). The top 50 feeder schools in both categories were compared using total school enrollment, degree status, geographic distribution, religious affiliation, and numbers of minority applicants. At the time of application 6,947 dental applicants reported attending 1,149 colleges and universities. The top 50 Category 1 schools had average enrollments of over 19,000 while Category 2 schools had average enrollments of 8000 students. California 3 and Utah had the greatest number of applicants followed by Florida and New York, all together accounting for 28% of total applicants. Seventeen of the top 25 Category 2 schools had religious affiliations, including the Seventh-day Adventist Church with 6 institutions followed by Roman Catholic (3), Methodist (3), Mormon (3), Lutheran (1) and Jewish (1). The majority of black and Hispanic applicants attended schools in the southeast (Florida, Tennessee, Louisiana), Puerto Rico and California. Results from this study indicate that the majority of dental school applicants are from colleges and universities with large student enrollments. However, many smaller schools, often affiliated with religious groups, have better applicant to enrollment ratios than larger institutions. Overall- and Hispanic- feeder schools are concentrated in heavily populated states while black-feeder schools are more regional. The majority of total applicants attended institutions in the Southwest region; minority applicants were concentrated in the Southeast. 2. Predental Enrichment Activities of U.S. Colleges and Universities 6 The purpose of this study was to examine pre-dental enrichment activities and their impact on the number of applicants from the nation s top dental school feeder institutions (DSFI). The DSFI were identified by their total number of applicants to dental schools and by their number of applicants per total student enrollment. A survey consisting of 25 yes/no questions on possible pre-dental enrichment activities was administered by phone or sent by to the top 88 DSFI, with 49 responding. Pearson correlation coefficients were used to measure the relationships among the number of applicants, pre-dental activities, and total student enrollment per institution. 4 The total number of applicants/institution was correlated with the total student enrollment/institution (r=.529) and the number of pre-dental activities/institution (r=.520). No correlation was observed between the number of activities at an institution and applicants per thousand enrolled. The percentages of DSFI with specific enrichment activities were: pre-professional health advising programs (96%), dental clubs (88%), volunteer programs (73%), specific pre-dental advising (69%), practice interview sessions (61%), shadowing program (59%), personal statement workshops (53%), committee for letters of recommendation (49%), clinical observation program (45%), oral health outreach to elementary/middle schools (39%), on-campus dental care facilities (37%), dentistry overview/introduction course (31%), DAT review course (27%), predental honors society (20%), affiliated dental school (20%), ASDA chapter (18%), special interest/minority dental group (16%), scholarships for pre-dental students (10%), combined degree program (10%), and pre-dentistry as a major (6%). Sixteen of the DSFI reported 10 or more enrichment activities. While larger institutions produced more applicants and had more activities, there was no correlation between the number of applicants per 1,000 students enrolled and the number of enrichment activities at an institution. The two activities most common to the top feeder institutions were a pre-professional health advising program and a dental club. Results indicate that there are specific pre-dental enrichment activities common to the top dental school feeder institutions in the United States, and that a better understanding of these may assist non-feeder schools in developing or strengthening an interest in dentistry as a career option. 5 3. Non-Academic Characteristics of Dental School Applicants 7 Non-academic factors are used by dental schools in selecting qualified, wellrounded students. The purpose of this study was to evaluate shadowing experiences, and extracurricular, volunteer, and research activities of the average dental school applicant. A database containing demographic, academic, and non-academic information for 1,116 applicants to the University of Connecticut School of Dental Medicine (UCSDM) 2005 entering class was generated using AASDAS Client and responses to AADSAS application questions. Quantitative and qualitative aspects of non-academic activities were assessed to generate a profile of the typical applicant. The data was analyzed using basic descriptive and inferential statistics without the use of applicant identification information. The average GPA of the applicant pool was 3.23 with a DAT Academic Average of Approximately 22% of the applicant pool reported working an average of 2270 hours as an assistant or hygienist. Of the remaining applicants, 86% reported an average of 172 shadowing hours with the majority (79%) in a general dentist office. Applicants participated in an average of: 3.7 extracurricular activities with 30% relating to arts/culture; 3.2 volunteer experiences with 35% directed towards public health; and 0.8 research projects with 80% involving biology. With the exception of shadowing, increased participation in any single non-academic area (extracurricular, volunteer, or research) resulted in similar increases for other two (p.01). As hours of shadowing increased, GPA declined. Nearly half (48%) of the applicants participated in three of the major non-academic areas; 42% in four. While academically similar, women reported 6 significantly greater (p .05) participation in all four non-academic areas when compared to their male counterparts. Results from this study suggest that the average dental school applicant participates in three or four major non-academic areas. The typical applicant reported a combined total of approximately eight extracurricular, volunteer, and research endeavors and 170 or more hours of shadowing. Participation in non-academic areas was correlated, with the exception of shadowing, as an increase in any one area resulted in similar increases in the other two. However, shadowing hours were negatively correlated with average GPA. In general, women were more active across all of the non-academic areas when compared to men. These results can assist admissions committees in making qualitative comparisons between applicants with similar academic qualifications and aid health career counselors in advising pre-dental students. 4. Dental School Applicants by State and Workforce Distribution 8 Millions of Americans face significant barriers that limit their access to oral healthcare. While many factors can affect access to care, the quality and quantity of a state s dental school applicant pool may also influence the ability to provide or maintain an adequate dental workforce. The purpose of this study was to evaluate the distribution of dental school applicants and dentists by state. Dental school applicant data by state was provided by AADSAS and direct (non- AADSAS) applications for the 2005 Admissions Cycle. Workforce distribution and population profiles were obtained from the ADA Survey Center or the U.S. Census Bureau. States were ranked based on applicant : population, dentist : population, and applicant : dentist ratios. State results were compared to national averages and 7 categorized to identify applicant or workforce shortages. Data was analyzed using basic descriptive and inferential statistics. Strong positive correlations existed between a state s total applicants and population (r =.958), applicants and dentists (r =.934), and dentists and population (r =.968). Based on the national average dentist : population ratio (1:1851), twenty states had a better overall ratio (1:1622) representing a combined surplus of 15,800 dentists; the remaining 30 states had a ratio of 1:2316. When comparing a state s total applicants or dentists to population ratios, 9 states had both ratios better than the national averages (Category 1), 11 states had better dentist : population but worse applicant : population ratios (Category 2), 13 states had better applicant : population but worse dentist : population ratios (Category 3), and for 17 states both ratios were worse (Category 4). Many of the Category 4 states were clustered in the Southeast and South Central regions. Based on national averages, many states had too few dentists to meet state population needs. In addition, many of these same states had too few applicants when compared to state population figures. States may wish to consider targeted initiatives aimed at increasing the sizes of their dental school applicant pools in order to address local and regional dental workforce shortages. D. Conclusions It is evident that a majority of applicants to U.S. dental schools are the products of relatively few colleges and universities. Although large schools tend to supply higher numbers of applicants, there are some small institutions that produce high proportions of dental school applicants when compared to their student body sizes. This suggests that there are some undergraduate institutions that are very effective in promoting and 8 fostering an interest in dentistry as a career. 5 A survey of the most successful feeder institutions revealed that these schools have a number of common predental enrichment activities, specifically preprofessional health advising, dental societies, and oral health volunteer programs. 6 The typical dental school applicant participates in about eight extracurricular, volunteer, and/or research experiences while accumulating an average of 170 hours shadowing a dental professional. 7 When considering the adequacy of the oral health workforce, it is important to consider the undergraduate colleges and institutions that supply applicants to dental schools as well as the nonacademic qualities that define such students. As these dental school applicants represent potential dental professionals, their quality and quantity has a direct impact on the dental workforce. It may prove useful to target students at the undergraduate level when developing strategies aimed at increasing the oral health workforce in a particular state or region. A consideration of the geographical distribution of the dental workforce and the dental applicant pool may also be indicated. It appears that many states do not have an adequate number of dentists to meet current and future state population needs. 8 Many of these same states also have very few dental school applicants when compared to overall population and dental workforce figures. In these instances, initiatives aimed at increasing the size of the dental applicant pools may be utilized to address local and regional dental provider shortages. The establishment of self-sustaining, predental programs modeled after successful feeder institutions may prove to be an important means of promoting interest in the dental profession and the ensuring the adequacy of the oral health workforce. 9 E. Epilogue An adequate supply of competent, well-trained, and culturally sensitive dentists is essential to meet the needs of America s public and private oral healthcare sectors. A thorough understanding of the dental school applicant pool is one of the first steps in ensuring the quality, quantity, and diversity of the oral healthcare workforce. It is important to consider what attracts potential oral health workers to the field and use this information in efforts to support a competitive applicant pool that can meet the future technological, scientific, and public health needs of the population. The research presented in this thesis attempted to characterize the most successful feeder institutions and their prospective dental school applicants. In addition, the dental school applicant pool was compared to state population and dental workforce estimates. It is hoped that information from these studies will provide a solid foundation for better appreciating the importance of the applicant pool and its impact on the future of the dental workforce. 10 Appendix A: Journal of Dental Education Publications - Characteristics of Dental School Feeder Institutions - Pre-Dental Enrichment Activities of U.S. Colleges and Universities - Nonacademic Characteristics of Dental School Applicants - Dental School Applicants by State Compared to Population and Dentist Workforce Distribution 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Appendix B: Reprint Permission and Copyright Notices Copyright notices Characteristics of Dental School Feeder Institutions. Reprinted by permission of Journal of Dental Education, Volume 68, 9 (September 2004). Copyright 2004 by the American Dental Education Association. Predental Enrichment Activities of U.S. Colleges and Universities. Reprinted by permission of Journal of Dental Education, Volume 69, 8 (August 2005). Copyright 2005 by the American Dental Education Association. Non-Academic Characteristics of Dental School Applicants. Reprinted by permission of Journal of Dental Education, Volume 70, 10 (October 2006). Copyright
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