Influence of contextual environment and community-based dental education on practice plans of graduating seniors.

This study investigated senior dental students' plans to provide care to underserved racial/ethnic minority populations. Three sets of determinants were analyzed: contextual environment, community-based dental education (CBDE), and student characteristics. We analyzed data from the ADEA Survey of Dental School Seniors and administrative data sources to construct contextual variables. Multivariable results show three contextual variables predicted practice plans: greater numbers of federally qualified health centers, higher percentages of underrepresented minorities, and attending a California Pipeline dental school. Regarding CBDE predictors, it was alarming to find seniors who viewed the cultural competency curriculum as inadequate and perceived themselves as less prepared to provide oral health care to diverse populations were also those most likely to serve minority patients. Significant student characteristics included racial/ethnic minority, female gender, older age, lower parent's income, and socially conscious orientation. The study provides evidence that contextual environment, CBDE, and student characteristics were significantly associated with plans to care for underserved patients. Findings suggest if the Pipeline initiative is successful in stimulating reform in U.S. dental schools, future students will develop greater awareness regarding critical access problems and the competencies required to effectively care for diverse populations. In the long term, addressing the problem of dental care access will require the creation of policy, financial, and structural interventions to motivate providers to care for the underserved.