Guest Perspective - Fall 2011

Recruitment of American Indians/Alaska Natives into the Dental Profession: What to Consider

Tamana D. (Bunny) Begay, D.D.S., Indian Health Service

It is no surprise to dental admissions personnel that there are few American Indians/Alaska Natives (AI/AN) in dental school. I graduated from the University of the Pacific Arthur A. Dugoni School of Dentistry with my D.D.S. degree in 2003 and have worked with many AI/AN pre-health professions students since. I have found common threads among them that may require special consideration by an admissions board. None of these are truly unique to the AI/AN student but apply to many students coming from low socioeconomic backgrounds.

One prevailing characteristic I have seen in the students I have worked with is that they are reserved or shy. Many AI/AN students have been raised in a specific confined area and have not had the opportunity to venture out of their immediate surroundings. The idea of "going off" to college is very scary. These students rarely have a support system in place to make it on their own. Some are the first in their families to seek a college education or degree, and their families do not always support their efforts.

Across the board, the majority of AI/AN students I have worked with were not ready for the challenges of a four-year college or university straight out of high school. The larger classes and the anonymity they bring allow too many students to slip through the cracks. Although these students are rarely unable to handle the coursework itself, they struggle with note-taking and organization, and their test-taking skills are lacking. Those who were academically successful in high school often feel defeated in their efforts if they do not make the grades they were accustomed to receiving. Some students are lucky enough to find the academic support they need early on; however, far too many wait until it is too late, and their grades reflect this. For the students I have worked with, this often results in self-doubt and increased homesickness. Being characteristically more reserved, they do not seek out emotional or academic assistance.

There is an alternative. Students can choose to stay close to home and begin their academic careers at a local community college or tribal college or through online courses. This is a plus for many students because they can remain in a familiar environment and have the opportunity to take courses in smaller, more manageable class groupings. In these settings, struggling students are more visible and more likely to be noticed by a professor.

I knew at the end of high school that I wanted to pursue a career in dentistry. Once I made that decision, I had to come up with a plan. I knew that one, I had to get away from my current home and community environment due to the level of responsibility and distraction they provided, and two, I would have to make school my priority. I knew once I looked into the requirements for dental school admissions it would be a long haul, so I mapped out a "long" plan. After that, it was one term at a time.

Upon leaving high school, I did not have the grades needed to apply to a four-year institution. This also made me ineligible for scholarships. I decided to attend a community college instead, a significant move for me because I needed to catch up academically, and it was affordable even as an out-of-state resident. This gave me good grounding for transferring to a four-year institution, and I was able to attain grades that opened more doors to scholarships and grants. Making the necessary grades also boosted my self-esteem, which helped me do well in the more demanding courses.

At the time, I remember the dentists I met at dental schools mentioning they did not like to accept students who took their coursework through community colleges. Although I heard this from many people, I could not let it deter me. I had no choice. If I wanted to become a dentist, I was going to have to start at a community college. Attending community college may have been an issue at that time, yet with the increasing costs of undergraduate education, I believe entering higher education this way will become a trend that more students will have to seriously consider. The reality is that students need to honestly assess where they will best succeed as they begin shaping their futures, and that may be a two-year community college program rather than a four-year school.

Whichever type of institution they choose to attend, AI/AN students also typically work jobs, often with long hours. There is pressure on them to contribute financially to either immediate or extended family, even while they are in school. Some students are fortunate to have some financial help from their tribes by means of scholarships. Those who intend to work for the Indian Health Service (IHS), a division of the U.S. Department of Health and Human Services, have the opportunity to apply for a scholarship or loan repayment.

Pipeline and post-baccalaureate programs have proven to be a valuable asset to AI/AN students who may have the commitment to work in dentistry but not the direction needed early on. These programs follow students and assist them in keeping on track. More critically, they give students an in-depth introduction into the field of dentistry as a whole. Students may not recognize how important it is to get experience in the field, especially through job shadowing or volunteering.

Without the type of preparation pipeline programs provide, AI/AN applicants may have difficulty conveying to dental schools the challenges they face and how they plan to overcome them. That is how I felt at that time. Fortunately, I participated in the University of California, San Francisco's post-baccalaureate program. There I learned how to comfortably frame my background in a personal statement. At the time that I was applying to dental school, there were few post-baccalaureate programs available. Now multiple schools (including Creighton University) offer programs, and they have done an excellent job in recruiting AI/AN students specifically.

Independent pipeline, post-baccalaureate, and mentoring programs also play an important role. The Association of American Indian Physicians (AAIP) is one organization that has assisted students through its National Native American Youth Initiative. This program brings approximately 60 AI/AN high school juniors and seniors to Washington, DC, each June for a one-week introduction to the health professions. Additionally, through the affiliated Association of Native American Medical Students, AAIP provides support to pre- and current health professions students. More recently, the Society of American Indian Dentists (SAID) established itself as a strong resource for our students when it began to collaborate with other national dental organizations in providing mentoring support to students.

Once they enter college, dental school, or an allied dental program, AI/AN students will benefit from and be most successful in professional programs that have established supports in place. Groups such as AAIP and SAID that strive to support students from high school through graduate school with workshops, mentoring, and conferences are an invaluable resource. There are numerous other organizations, such as the AAMC/ADEA Summer Medical and Dental Education Program, that have also stepped forward to aid AI/AN students in their quests to become dental professionals. Seeking out such programs and attending them requires some finesse and courage from our students. This is when mentoring becomes essential.

The first woman dentist I met was the person who introduced me to dentistry, and her encouragement early on influenced me more than that of anyone else. She is also the person who helped me put a loose plan together to seek work with the Indian Health Service. She knew that if I focused on giving back, it would give me the direction I needed. Now when I have the chance with my pediatric patients to ask them about school and careers, I do, and of course I plug the dental field. It is exciting for me to see more and more AI/AN native students graduating from dental schools, and then coming to serve the AI/AN communities as clinicians and mentors.