Spending the spring before graduation with your hands in strangers’ mouths might not be every student’s cup of tea. Kaitlin Poppe, however, couldn’t have enjoyed herself more.
Dr. Poppe, who received her dental degree from the University of Washington in June, spent the spring at the Yakima Valley Farm Workers Nob Hill clinic in Yakima in a clinical rotation for the UW School of Dentistry. The rotation was part of the school’s Regional Initiatives in Dental Education (RIDE) program, which was launched in 2007 with state funds. In addition to Dr. Poppe, UW dental students fanned out to rotations at community clinics in Colville, Moses Lake, Spokane, Lake Spokane, Wenatchee, Othello and Okanogan.
“Every day I was treating someone who otherwise would not receive care. Every day I knew I was making a difference in someone’s life, and I don’t think there is anything more rewarding than that,” Dr. Poppe said.
Built with the help of Eastern Washington University’s dental hygiene program, RIDE was created to improve access to dental care in rural and underserved areas of the state, especially in Eastern Washington.
Dentists are clustered heavily along the I-5 corridor in Western Washington, but far less so east of the mountains. For example, in 2007, King County had six times as many dentists per capita as Pend Oreille County in Washington’s northeast corner.
Aside from availability, other factors that affect access to care include income and insurance coverage. “I have always been aware of the need for community dentistry, but was not aware of the extent of the need,” Dr. Poppe said. “We had patients who drove from hundreds of miles away to be seen at our clinic because we are the only ones who will see them. I always thought access-to-care problems were due to geography, but now realize that it is much more than that.”
The clinics where the RIDE students worked generally see a high proportion of patients who live below the poverty line, are on Medicaid or have no insurance. A significant number are children.
“The RIDE program is one of the great ways to increase access for low-income and Medicaid-insured children and adults,” said Dr. Bruce Wilcox, the dental director at Columbia Valley Community Health in Wenatchee. “The rotations are certainly a win for the students, but also for us and our patients.”
RIDE students are supervised by their clinical preceptors and other licensed dentists while seeing patients – more closely at the outset of their rotations, less so as they become more proficient. Few patients object to being treated by a student clinician.
“Patients’ response to the RIDE students has been overwhelmingly positive,” said Dr. Ryan Busk, dental director at the Family Health Centers Dental Clinic in Okanogan. “The most commonly heard expression is, ‘Yes, I would love to work with the student – everyone has to learn sometime.’”
This year marked the second group of students to graduate from the RIDE program, which is a special track at the School of Dentistry that enrolls eight students each year. RIDE students spend their first year at the Riverpoint campus in Spokane, a joint venture of Washington State University and Eastern Washington University. They study alongside medical and dental hygiene students, using the latest distance-learning technology.
RIDE is also a partnership with the UW’s WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) regional medical education program. It is a successful, established model that helps supply young physicians to rural and underserved areas in the Northwest.
“We’ve had the advantage of WWAMI’s tremendous experience over more than 40 years, and we’re finding additional benefits as well,” said Dr. Wendy Mouradian, associate dean of regional affairs and RIDE at the UW School of Dentistry. “RIDE Is also a terrific example of collaboration among public universities to address community needs – in this case, for dental care.
“RIDE has also partnered with the private dental community, especially the Spokane District Dental Society, as well as public health clinics,” Dr. Mouradian said. “It has helped us learn more about interprofessional education, which is becoming a major element of medical and dental education. All the medical and dental students at Riverpoint gain a great deal from their mutual association, including a better understanding of the patient’s overall health outside their own discipline.”
With distance-learning technology playing an expanding role in professional education, RIDE’s experience is proving invaluable here as well, Dr. Mouradian said, expanding the School of Dentistry’s educational technology infrastructure to include the Riverpoint campus and RIDE community sites.
RIDE students spend their second and third years with their other dental classmates at the UW in Seattle, and then spend the spring of their fourth year at one of several Eastern Washington community health centers. They also participate in an earlier summer clinical rotation.
“We believe that when our students spend extended periods of time in these communities, work with local providers and get to know the residents, they’re much more likely to want to settle there and practice,” Dr. Mouradian said.
That’s how Dr. Eric Nygard sees it after completing his rotation at the Lake Spokane Community Health Center. “This is a fascinating community, one that my wife and I have discussed moving back to,” he said. “The people in this community are very supportive of each other.”
After receiving his DDS, Dr. Nygard began a dental anesthesia residency at Loma Linda University in Southern California, but he planned to return.
“After this residency, I plan to move to Eastern Washington to serve the communities there as a dentist and dental anesthesiologist, largely serving pediatric and special-needs populations,” he said. “My rotation has influenced my thinking about community dentistry, because I can see that some populations would otherwise not receive comprehensive dental care without access to community dental clinics,” he said.
“I’m a fan of mentoring in all phases of life,” says Dr. Dorothy Stewart. And as a mentor, she has the kind of professional and life background that students treasure when they need counsel and support.
Since mid-2010, Dr. Stewart has been the liaison between RIDE students and the UW Department of Restorative Dentistry. She helps students track their requirements for graduation and complete their clinical competencies, but that’s not all. While students meet with her to discuss issues in the classroom or clinic, some inevitably share other – often personal – concerns.
“A lot of them are overwhelmed or frustrated, especially in second year,” Dr. Stewart says. “Much of the time, I’m reassuring them: ‘You will be good – it just takes practice.’ ” With her encouraging manner, it’s not hard to see why she’s known by some as “the RIDE mom.” She started building that reputation as an affiliate faculty member in Restorative Dentistry, where she would bring treats for holidays.
The move into RIDE was a natural progression for Dr. Stewart, who began teaching in Restorative Dentistry in 2007. She had volunteered at the suggestion of Dr. Scott Neuhaus, a School of Dentistry classmate (Class of 1982) after selling her practice of 25 years in Spokane and moving to Seattle. In large part, the move was to be closer to her only child, Sara, who was then working toward her DDS at the UW and recently completed her Orthodontics residency at the School of Dentistry.
“We had a lot of fun talking before and after clinic and eating lunch together when I was still in dental school,” Dr. Cassidy says. “It was quite amazing to see how life had come full circle: I was born at the UW while she was in dental school and here we were again, in dental school together – but this time I was the student.”
The thread of dentistry runs deeply through the family. Dr. Stewart is a third-generation dentist, and practiced with her father for years until his death. Even with this background, her path toward becoming a dentist was unusually demanding.
She started as a hygienist, obtaining her degree in 1972 as one of the last graduates of the UW’s full four-year hygiene program. She didn’t decide to become a dentist until her late 30s, prompted by a belief that she could do a better job of listening to patients than the dentist who then employed her. She had her daughter between her second and third years of dental school. Shortly afterward, her marriage ended and she finished school while carrying the burdens of single motherhood – and did so ranked high in her class. So when students come seeking the voice of experience, Dr. Stewart can supply it with authority.
Her current schedule calls for her to spend four half-days teaching in clinic, one full day teaching Fixed Prosthodontics to second-year students, and one day on RIDE administrative and related duties. She also frequently stays late to accommodate students who want to consult with her, especially the ones who are working in the lab.
Three times a quarter, she meets with students and has them fill out a spreadsheet showing how they’re meeting course requirements. Much of her contact with them is informal, though.
She meets with the first-year RIDE classes at the Riverpoint orientation in Spokane in August, but her real contact with them starts when they return to Seattle the next year and take Fixed Pros. She finds it hard to contain her excitement when the teaching starts.
“These are all very bright students,” she says. “I love teaching at this level.”
Students hold her in high regard. “She has a reputation of being one of the best clinical instructors in the dental school, while also being one of the kindest,” says fourth-year RIDE student Eric Nygard, who recalls how she helped him get over a daunting clinical hurdle: his first filling on a live patient.
“She allowed me to clear my mind by verbally walking through the steps of the procedure before proceeding, then giving supportive encouragement,” he says. “After talking to her, I felt completely clear in what I needed to do, and I felt completely confident that I could do it. The restoration went great, and I have since done many others, but getting that first one was a big deal for me.”
He sums up: “Dr. Stewart is awesome.