A Dental Student for Our Time: Holistic, Community-Minded, Diverse, Transformed

Tuesday, January 24, 2017

By Jonathan Sapers 

 

When Victor Lee was studying pharmacology as a pre-med student at Stony Brook University, he was sure of one thing in terms of a career goal. “It’s really funny because I actually did not want to be a dentist at all,” says the fourth-year student at Columbia University College of Dental Medicine. “It was literally the last thing on my list.”

The reason was personal. His father had been a dentist in China but had given it up to get his family to the United States. After arriving here, he worked odd jobs to feed his family, says Mr. Lee, including cooking in a takeout restaurant. But he never forgot his previous profession and encouraged his son to pursue it. “You should think about it,” his father kept suggesting. “Think about it.”

After graduating from Stony Brook, Mr. Lee did think about it. He tried working in two dental offices and became so inspired by the dentists he worked for that he did change his mind. “They were really good mentors,” he says. “I really liked the way they interacted with their patients. It was definitely eye-opening.”

He studied hard for the dental school entrance exams and did well, but did not get accepted to Columbia on his first attempt after taking the test late and missing the application deadline. Still, he remembers loving the school’s atmosphere and can even name the students he met during his visit.

Over the next year, he kept in touch with the school, kept working at the dental offices and, in his spare time, coached a local dragon boat team (a kind of competitive rowing that takes place in a 20-person craft mounted with a dragon’s head). He also competed in the world dragon boat championship in Europe. He was accepted at Columbia on his second try and hit the ground running.

Something of a self-described wallflower at Stony Brook, Mr. Lee has been transformed at Columbia. He is a chatty popular campus character, greeting other students as he gives a visitor a tour and joking with faculty and administrators. He has served as an admissions ambassador and vice president of the American Student Dental Association and is president of his class. He is also studying at night for a dual degree in science education at Columbia’s Teachers College and will remain at Columbia next fall for a prosthodontics program. He is a dyed-in-the-wool devotee of all things Columbia. “I never really understood what school spirit was about until I got here,” he says. “Man, I’m pretty proud to say I’m from Columbia.”

Welcome to the new world of Columbia’s College of Dental Medicine, where the venerable school is evolving to adapt to and shape a profession being transformed by scientific advances, drawing on its tradition that requires students to take their first year and a half alongside medical students. It is for that reason, even as it begins to implement a new master space plan, that it never considered leaving its facilities within Columbia’s medical center. Sharing a campus not only with the medical school, but also with schools of nursing and public health benefits the school as it anticipates a future where dentistry will become more deeply integrated with the total health care system.

“We have drawn a line in the sand that we are going to educate our graduates as oral health physicians,” says Dennis Mitchell, DDS, vice provost for faculty diversity and inclusion and associate professor of dental medicine. “It’s clear that parts of our profession are moving against that and away from that. But we’re holding the line.”

More than holding the line, the school is further advancing its integration of oral health care into general health care through facilities renovation. It has acquired an additional floor in the Vanderbilt Clinic to build a modern clinic with chairs that are not only equipped with the latest technology but also are designed to accommodate the new approach to dentistry that the school believes is just around the corner if not already here: general dentists sharing space with nurses and social workers and practices with colleagues across the specialties, including pediatric dentists and orthodontists.

Significant change is coming as dentistry is swept into the insurance fold by inclusion of children’s dental care in the Affordable Health Care Act, as it now stands, says James Fine, DMD, senior associate dean for academic affairs.

The change will require a shift in perspective for dentists, who will need to take an increasingly holistic approach. “You approach the patient in a holistic manner, starting with the patient’s mind, and factor in the patient’s well-being,” says Dr. Fine. “You then move to the whole body, and then head and neck, then to the jaw, and then, finally, to the teeth.”

From the insurance perspective, it will no longer be acceptable for dentists to avoid tracing oral health issues back to other causes, such as diabetes, smoking, and alcohol use. “Given the government’s expanding role as a payer for dental care, we expect to see changes in the way dentists are reimbursed,” Dr. Fine says. “We’ll be reimbursed for helping maintain the overall wellness of the patient. What matters is not that you fixed one tooth but you prevented the patient from losing the rest of his teeth.”

The new approach will require more holistically and humanistically trained dentists, attentive to issues beyond the mouth. The school has a pain management clinic where nursing and social work students work alongside dental students to diagnose patients’ discomfort. The school also has increased the amount of time students spend in clinical training.

Dr. Fine believes this new wider focus may, in time, replace the solo practitioner model of care. “Like optometry and medicine before it, dentistry will be incorporated into larger systems of care,” he says.

And Dr. Fine believes the pace of change in the profession, accelerated by technology and research, will be breathtaking. “It used to be that you could train a student without anticipating a lot of changes in how they would practice five, 10, 15, even 20 years down the line,” he says, “but the impact of outcomes research and technological advances is increasing. In five years, our students are going to start seeing changes in treatments, techniques, reimbursement, and data management.”

One way the school has begun to prepare students for these changes is by offering dual degrees that broaden students’ abilities. The school is also spending more time exposing students to new technology. “For decades, we would put a tiny piece of film in the patient’s mouth and just take images of the tooth,” Dr. Fine says. “We’ve moved to imaging larger parts of the patient’s head and neck areas and using 3-D images to help provide more accurate diagnoses. We use scanners connected to 3-D printers so instead of taking an impression of your teeth to make a replacement, we scan the area and have it 3-D printed or milled or CAD-CAMed.”

But Dr. Fine says the new realities of dentistry will not be the school’s only concern. It also will focus on expanding students’ participation in working with underserved communities in accordance with Columbia University’s core values. “One of Dean Christian Stohler’s goals is that we will offer more care to underserved populations in locations ranging from Manhattanville to other parts of the world. We want to instill a commitment to serving the underserved early on in our students’ careers.”

Simultaneously, the school has begun to tweak its admissions efforts. Not by adjusting its high standards (the school has vied with Harvard for first and second place in terms of the academic excellence of its admitted students for the past decade), but, as Sandra Garcia, assistant dean of admissions and student affairs, puts it, “really paying attention to everything else.” And one constant in the new student population seems to be the school’s apparent success in attracting students who already have an interest in working with the underserved communities that Dr. Fine mentioned.

For example, Mary Awadallah, a fourth-year student who will begin a postdoctoral orthodontics program at Montefiore Medical Center next fall, missed the opportunities she had while at Yale to mentor younger girls and decided to start a mentoring program at Columbia called Bloom. “We go once a week, mentor the middle school girls, talk to them about different subjects of relevance to middle schoolers—body image, healthy eating, racism and sexism, personal identity, confidence building,” Ms. Awadallah says.

Middle school is a difficult period and Ms. Awadallah says sometimes just the physical presence of mentors helps. “When your confidence is wavering, through the peril, the turbulence of middle school, just having an older girl go and spend time with you shows you that you matter.”

Ms. Awadallah remembers going to the orthodontist as being a positive antidote to her own difficult middle school experience as a child of immigrant (Egyptian) parents growing up in suburban Long Island. And she dreams of one day having an orthodontic practice that would play the same role for other adolescent girls. “I want to have a practice where I’m seeing middle school and early high school kids and then seeing their siblings grow up and also needing ortho treatment and have everyone in the neighborhood say, ‘Oh, yeah, Dr. Mary’s my orthodontist.’”

Scott Bueno, a third-year student, also was inspired to start his own mentoring program by his experience in college. He was an officer with the Sage Mentorship Program at Berkeley, and during his interview at Columbia, he made a point of asking if he could start a similar program at CDM. He was gratified when his interviewer said Columbia was “the place to do it.”

So Mr. Bueno started Heights Helpers, which pairs dental students with sixth graders at a nearby charter school. “The idea is that you’re a positive role model for kids who need a little extra

help in school,” Mr. Bueno says. “We go there weekly for an hour and a half. It’s a continued program because there are lots of programs where you’ll go in for the day, for the week, just long enough for the kids to learn to trust you and then you leave and you might not come back for a year or at all. So then the kids are afraid to trust anyone again.”

For Mr. Bueno, the program is an outgrowth of his interest in health care. “I like to give back and to help people,” he says. “I think it’s the kind of person you’re going to attract to the health care profession in general, but here at Columbia I see that more so than anywhere else that I interviewed.”

Cultivating an environment that welcomes student projects is taking on increasing importance for the school. Behind the scenes, Ms. Garcia says, setting up Heights Helpers was not a slam dunk. Several rounds of discussions were held before a framework could be developed. But having the flexibility to allow the students to build their own organizations and have a say in how the school operates is an important part of the school’s values system.

That spirit is also reflected in the extent to which students are now involved in the admissions process itself. According to Ms. Garcia, several years ago students began asking if they could participate in interviews with prospective students, could give students tours, answer their questions, and take applicants to lunch. So the school developed an admissions ambassador program.

The change sent a message to incoming students. “I think that when someone decides they want to come here after seeing that, they know that there’s an opportunity for them to be involved at that same level,” Ms. Garcia says. “And that as an institution we encourage students to be involved and we listen to them. I think that’s refreshing.”

Divya Khera, a 2015 graduate now in a pediatric dentistry residency at Columbia, says she immediately picked up from students she met on her visit that Columbia would be different from her undergraduate experience. “Duke is pretty cutthroat especially when you’re in the sciences and I really wanted to be in an environment for grad school where I felt that it was collaborative and I felt the students really helped each other.”

Her parents, Indian-born physicians who came to the United States in their 20s, wanted her to go to the University of Pittsburgh, near her hometown of Erie, Pa. But when Dr. Khera was accepted at Columbia her father agreed to visit with her and see what had impressed her.

Dr. Khera’s father was won over by the admissions staff, particularly Laureen Zubiaurre Bitzer, DMD, associate dean for predoctoral admissions and associate professor of clinical dental medicine, known affectionately to students as “Dr. Z.” After a meeting and a tour with Dr. Z, Dr. Khera’s father was all in. “My dad’s like, ‘Yeah, you’re going here. I see what you mean.’”

The effort to focus on the “everything else” that Ms. Garcia referred to has resulted in a successful effort to diversify the student body, says Dr. Mitchell. Each 80-student class in the dental school now has a critical mass of underrepresented minorities—20 percent in each class and 24 percent for the newest class, the Class of 2020.

In 2002, the school’s percentage of underrepresented minorities was only 3 percent—one minority student in the first-year class. Since then, when Dr. Mitchell, a former public health dentist who now splits his time between the dental school and Columbia University’s senior administration, was called in to help improve the numbers, they have steadily climbed. One key factor Dr. Mitchell attributes to the change: The dental school created the dental component of what is now the Summer Medical and Dental Education Program, a program funded by the Robert Wood Johnson Foundation that brings pre-medical and pre-dental undergraduate students of color to campuses across the country each summer. The program regularly yields dental school students. As Dr. Mitchell tells it, in 2002, a medical student in the program hosted by Columbia (the program did not then have a dental component) asked if he could focus on dentistry instead and the dental school helped him do it. “It just so happened the stars were aligned,” Dr. Mitchell says. “There was a site visit that summer and the Robert Wood Johnson people interviewed the student about his experience. The foundation then asked us to consider piloting a dental program for a couple of years.” Now, nine of the program’s 12 sites host dental students in the summer (but none is more popular than Columbia’s, Dr. Mitchell says).

The underrepresented minority students are showing impressive leadership qualities. Recent statistics include three of the past eight presidents of the Student National Dental Association (a historically black student dental association), successive trustees of the Hispanic Student Dental Association, and chapter of the year awards in both organizations, not to mention the first black student body president and the first black president of the American Student Dental Association.

Dr. Mitchell says he is not surprised by those achievements, but he points out that students only get to showcase those skills if they have their school’s support, including a willingness to pay for students to travel to events. “Dean Stohler has placed a new level of energy and dedication on this,” Dr. Mitchell says. “We didn’t have resources targeted to bring our students to national forums before, and he has committed those resources.”

For this year’s Hispanic Dental Association meeting, for example, the school sponsored 18 students plus faculty members, the dean, and Dr. Mitchell. “We went there in force,” Dr. Mitchell says, “just to remind everybody that Columbia is the place to be. Also, it says to the other student leaders that they might want to consider coming to Columbia for residency or to specialize.”

Support at school matters too. Each year Dr. Mitchell selects an older minority student to support and mentor younger ones. This year’s selection was Chelsea Townes, an aspiring pediatric dentist from Hackensack, N.J., who in May received dual degrees from Columbia’s College of Dental Medicine and the Mailman School of Public Health.

In college, Dr. Townes was interested in public health and worked for two summers in the Bergen County Health Department. Then she happened to go to her dentist. “We were just talking and I told him I was working at this public health department and how crazy political it is and how pressured it is. He asked me if I had ever thought about dentistry.”

Dr. Townes had not, but she became interested and decided to give it a try. After graduating from Penn, she completed a postbac at Columbia before starting at the dental school.

Although her dentist and mentor had been concerned that Columbia might be too stuffy for her, Dr. Townes was pleasantly surprised. “They told us the medical curriculum had been condensed so a shift toward making sure we have more clinical work was possible.”

That meant Columbia was a place where she didn’t have to give up her former interest in public health. “I always knew I wanted to continue doing public health if I could,” she says. “But doing clinical work and having one-on-one interactions with patients is definitely a goal for me. I don’t want to ever just sit behind a desk and do research.”

Dr. Townes has now started a pediatric residency on Long Island. “My dream would be to combine pediatrics with public health, community outreach, teaching, everything. But that would be a dream. I’ll see if it actually happens.”