Identifying Needs to Ensure a Humanistic Academic Dental Environment: A Multi-Site Survey of Dental Students' Perspectives

Discrimination and dental students: What is the reality in Brazilian institutions?

INTRODUCTION

This study aimed to evaluate whether there is discrimination in the dental educational environment, assess the main reasons for the discriminatory events, and if there is an association between discriminatory episodes and sociodemographic characteristics of undergraduate dental students.

MATERIALS AND METHODS

This observational cross-sectional study was conducted with a self-administered questionnaire to students enrolled in three Brazilian dental schools. Questions included sociodemographic characteristics and the occurrence of discriminatory episodes in the dental academic environment. Descriptive analysis was performed in RStudio 1.3 (R Core Team, RStudio, Inc., Boston, USA) software and the associations were tested using Pearson's chi-square test, considering 95% confidence intervals.

RESULTS

A total of 732 dental students were included, with a response rate of 70.2%. The vast majority of students were female (66.9%), with white/yellow skin colour (67.9%), and with a mean age of 22.6 (SD 4.1) years. Sixth-eight percent of students reported having experienced some discrimination in the academic environment and most reported feeling uncomfortable with the episode. The main reasons to have been discriminated against raised by students were specific behaviour/habit, have specific moral, ethical, and aesthetic values, gender, and socioeconomic status or social class. The occurrence of discriminatory episodes was associated with female gender (p = .05), non-heterosexual sexual orientation (p < .001), studying in public institutions (p < .001), receiving an institutional scholarship (p = .018), and being in the final undergraduate cycle (p < .001).

CONCLUSION

The occurrence of discriminatory episodes was common in Brazilian dental higher education. Discriminatory situations generate traumas and psychological marks, causing a loss of diversity within the academic environment that leads to loss of productivity, creativity, and innovation. Thus, strong institutional policies against discrimination are crucial to create a healthy dental academic environment.

Applying a systems oriented ethical decision making framework to mitigating social and structural determinants of health

Objectives

Clinical ethical decision-making models are largely geared toward individual clinician choices and individual patient outcomes, not necessarily accounting for larger systemic issues that affect optimal patient outcomes. The purpose of this paper is to provide an ethical decision-making model, drawing upon systems orientation and ethical theory, specifically incorporating and aiding in the mitigation of social and structural determinants of health.

Methods

This paper presents a systems-oriented ethical decision-making framework derived from the analysis and critique of the Four-Box Method for Ethical Decision-Making by Jonsen, Siegler, and Winslade. Drawing upon both deontological and utilitarian ethical theory, the developed framework will assist providers, organizations, and health system leaders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations, who are largely impacted by social and structural determinants of health.

Results

The needs of underserved patients are inextricably linked to various social and structural determinants of health that, if left unaddressed, result in even poorer health outcomes, exacerbating existing health disparities. A systems-oriented ethical decision-making framework, centered on obligation, duty, and a utilitarian view of the optimal good, will aid providers, organizations, health system leaders, and community stakeholders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations.

Conclusion

Socioeconomic and political contexts have a significant impact on the way society is organized, how people are positioned in society, and how they will fare in terms of their health. Healthcare providers, including dentists, are largely unaware of and insensitive to the social issues that underlie the biological or psychological concerns that patients from socially disadvantaged backgrounds face. A systems-oriented ethical decision-making model will aid in mitigating social and structural determinants of health and the dental profession's obligations to the underserved.

A cross-sectional study investigating mental health and resilience among pre-doctoral students at a US dental school

PURPOSE/OBJECTIVES

This study explored key mental health measures as self-reported by pre-doctoral dental students enrolled in all four years of dental school and their relationships with a year in school and resilience.

METHODS

This study utilized archival data from the National Collegiate Health Assessment (NCHA) survey administered in Fall 2020. This instrument is a compilation of validated measures assessing a broad spectrum of health-related behaviors, including nutrition, substance use, social relationships, and mental health. The mental health measures explored in this study included validated scales assessing mental distress, suicide behavior risk, psychological well-being, and resilience.

RESULTS

Students in all 4 years of dental school completed the survey (62% response rate). Most students reported high resilience, positive psychological well-being, and moderate mental distress, with mental health challenges spiking in the D2 and D3 years. Resilience emerged as a protective factor for student mental health. Years in school did not retain a significant impact on mental health when controlling for resilience.

CONCLUSIONS

Resilience is important in bolstering dental students' mental health. Dental students' mental health challenges increased during the D2 and D3 years. Dental educators may positively influence student well-being by taking measures that foster resilience at the beginning of and midway through dental school.

Can academic dentistry become an anti-racist institution?: Addressing racial battle fatigue and building belonging

Racism, oppression, and marginalization are unfortunate hallmarks that Black individuals face in the United States. While dental schools serve as institutions of both learning and patient care, applying humanistic principles, they are not immune to racism, specifically anti-Black racism. In this paper, the theoretical framework of racial battle fatigue is applied to academic dentistry to consider how it may impact faculty who have experiences with racism and discrimination. The framework of racial battle fatigue allows for a critique of academic dentistry as an institution that may be toxic, neither welcoming Black faculty members nor supporting their professional and career advancement, despite accreditation standards that call on these institutions to be humanistic environments for diversity and inclusion. Black faculty members may face unique challenges in academic dentistry because of racial battle fatigue. The cumulative stress may warrant unique strategies to both recruit and retain them in academic dental institutions. Specifically, pathways may need to be funded to insure that they have support and time allocations for professional development and career promotion. With understanding the effects of racial battle fatigue, dental schools may want to adopt policies and practices that support the professional and personal well-being and success of faculty, especially those faculty members who are Black.