Service Learning Collaboration &Service Learning Collaboration &The Integration of The Integration of

Lutheran Medical CenterLutheran Medical CenterPostdoctoral Residency Training Postdoctoral Residency Training Programs in Community Health Programs in Community Health

CentersCenters

Neal Demby, DMD, MPHNeal Demby, DMD, MPHDirector, Dept of Dental MedicineDirector, Dept of Dental Medicine

Anna D’Emilio, DDSAnna D’Emilio, DDSDirector, AEGD ProgramDirector, AEGD Program

Bernard Tolpin, DDS, MPHAssociate Director, Dept of Dental

Medicine

Susan Dietrich, DDSDirector, Graduate Dental Education

Lutheran Medical CenterLutheran Medical Center

476 + bed  teaching hospital476 + bed  teaching hospital

Level 1 Trauma CenterLevel 1 Trauma Center

Only hospital-based CHC (Federally qualified health Only hospital-based CHC (Federally qualified health center) in the countrycenter) in the country

600,000+ encounters at main site600,000+ encounters at main site

75,000+ dental encounters at main site75,000+ dental encounters at main site

120,000+ dental encounters at extramural partnership 120,000+ dental encounters at extramural partnership sitessites

Culturally Diverse PopulationsCulturally Diverse Populations

Service Learning MissionService Learning Mission

Recruitment & retention of oral health providers Recruitment & retention of oral health providers remains a critical and chronic problem in assuring remains a critical and chronic problem in assuring access to care; centers face challenges with workforce access to care; centers face challenges with workforce and budgets.and budgets.

Through the establishment of creative, collaborative Through the establishment of creative, collaborative partnerships between LMC dental education programs partnerships between LMC dental education programs and community health centers, a major workforce and community health centers, a major workforce initiative has been put in place to develop a cost initiative has been put in place to develop a cost effective means for centers to ameliorate access issues effective means for centers to ameliorate access issues for the most vulnerable . for the most vulnerable .

Health centers have the resources to provide the Health centers have the resources to provide the learning/educational environment to new dentists.learning/educational environment to new dentists.

Collaboration AdvantagesCollaboration Advantages

LMC pays resident salary & benefitsLMC pays resident salary & benefitsLMC provides financial reimbursement to LMC provides financial reimbursement to

sites for administrative timesites for administrative timeSite retains all income generated by the Site retains all income generated by the

residentresidentLMC consultant faculty appointmentLMC consultant faculty appointmentCE opportunities; faculty developmentCE opportunities; faculty developmentADA accreditation of clinical training siteADA accreditation of clinical training siteRecruitment and retention of providersRecruitment and retention of providers

““Win-win situation”Win-win situation”

Collaborative PartnershipsCollaborative Partnerships

Community Health Community Health Centers (FQHCs)Centers (FQHCs)

Public Health Public Health DepartmentsDepartments

Indian Health ServicesIndian Health Services Group practices (profit & Group practices (profit &

non-profit)non-profit) Health Science CentersHealth Science Centers

Managed Care Managed Care OrganizationsOrganizations

Veterans AdministrationVeterans Administration Community HospitalsCommunity Hospitals Health DepartmentsHealth Departments AHECAHEC Prison Health SystemsPrison Health Systems

PRIMARY CARE DENTAL RESIDENCY

(Initial Program Yr)

ADA COMMISSION ON

DENTAL ACCREDIATION(Latest approval)

LENGTH OF PROGRAM

NUMBER OF

RESIDENTS

ENROLLED

2008-2009

GENERAL PRACTICE RESIDENCY (GPR)

1974

APPROVAL2002

1 YEAROPTIONAL 2ND

YEAR11

ADVANCED EDUCATION IN GENERAL DENTISTRY

(AEGD)1988

APPROVAL2006

1 YEAROPTIONAL 2ND

YEAR

73

ADVANCED EDUCATION IN PEDIATRIC DENTISTRY

1994APPROVAL

20022 YEARS

26

ADVANCED EDUCATION IN ENDODONTICS

2004

APPROVAL2007

2 YEARS 6

DENTAL ANESTHESIOLOGY2008

INITIAL ACCREDITATION

20082 YEARS 8

LMC Program & Partnership LMC Program & Partnership EvolutionEvolution

AEGD ProgramAEGD Program

19881988

1 resident; 1 site1 resident; 1 site

20082008

73 residents; 61 sites73 residents; 61 sites

PEDS ProgramPEDS Program

19941994

2 residents; 1 site2 residents; 1 site

20082008

26 residents; 3 sites26 residents; 3 sites

Current States: Alaska, Arizona, California, Colorado, Hawaii, Massachusetts, Maryland, Michigan, Mississippi, New

Mexico, New York, Rhode Island, Tennessee

Future: New Jersey, Oregon, Connecticut, New Hampshire

Lutheran Medical Center Dental Residency Network

ALA

SK

A

Yukon-Kuskokwin Health Bethel, Alaska

AR

IZO

NA

Mountain Park Health Center 635 East Baseline Road Phoenix, Arizona 85042 AEGD Residents

El Rio Health Center Northwest 4009 N Flowing Wells Tucson, Arizona 86705 AEGD Residents

North Country CHC Flagstaff, Arizona AEGD Residents

Winslow Indian Health Center Winslow, Arizona AEGD Residents

Sells Indian Health Service AEGD Residents

Mariposa Community Health Center 1852 N

Mastick Way Nogales, Arizona 85621

AEGD Residents

Dental Net 1057 N Kolb Road Tucson Arizona 85710 AEGD Residents

Sun Life Family HC 865 N Arizona Road Casa Grande, AZ 85222 AEGD Residents

Dental Net 4747 N 7th Street Phoenix, Arizona AEGD Residents

Dental Net 5905 W Bell Road Glendale, Arizona 85308 AEGD Residents

El Rio Health Center Southwest 1530 Commerce Street Tucson, Arizona 85746 AEGD Residents

Pascua Yaqui Tribal Dental Center 7490 S. Camino De Oeste Tucson, Arizona 85746 AEGD Residents

EL Rio Health Center Downtown 639 W Congress Street Tucson, Arizona 85745 AEGD Residents

CO

LO

RA

DO

Marillac Clinic Grand Junction, Colorado AEGD Residents

Valley Wide Health Center 186 Hurt Street Center. Colorado AEGD Residents

Valley Health Center 204 Carson Avenue Alamosa, Colorado 81101 AEGD Residents

Valley Health Center 375 East Park Avenue Durango, Colorado 81301 AEGD Residents

HA

WA

IIA

N I

SLA

ND

S

Keaau Family Health Center Dental Clinic 16-192 Pilimua Street Keaau, Hawaii 96749 AEGD Residents

Maui Oral Health Initiative 310 W Kaahumanu Avenue Kahuliu, Hawaii 96732 AEGD Residents

Kokua Kalihi Valley 2239 N School Street Honolulu, Hawaii 96819 AEGD Residents

Kalhi-Palama HC 915 N King Street Honolulu, HI 96817 AEGD Residents

Kaua’I Community Health Center 4643 Waimea Canyon Drive Waimea, Hawaii 96796 AEGD Residents

Waianae Coast Comprehensive HC 86-260 Farrington Highway Waianae, Oahu, Hawaii 96792 AEGD Residents

BO

STO

N M

AS

SA

CH

US

ETTS South Cove Community HC

885 Washington Street Boston, MA 02111 AEGD Residents

South Cove Quincy 275 Hancock Street Quincy, MA 02171 AEGD Residents

Codman Square Health Cener Washington Street Dorchester, MA 02124 AEGD Residents

Harvard Street Health Center Blue Hill Avenue Dorchester, MA 02124 AEGD Residents

Dorchester House Health Center 1353 Dorchester Avenue Dorchester, MA 02122 AEGD Residents

Dimock Community Health Center 55 Dimock Street Roxbury, MA 02119 AEGD Residents

Whittier Street HC 1125 Tremont Street Roxbury, MA 02120 AEGD Residents

Boston Public Oral Health 774 Albany Street Roxbury, MA 02118 AEGD Residents

Joseph M Smith Family Health Center 287 Western Avenue Alston, MA 02134 AEGD Residents

NEW

MEX

ICO

Indian Health Service Dental Clinic Albuquerque, NM AEGD Residents

Acomo-Canoncito-Laguna Indian Health Service Grants, NM AEGD Residents

Santa Fe Indian Health Service Hospital 1700 Cerrillos Road Santa Fe, NM 87505 AEGD Residents

METR

OP

OLIT

AN

NY

AR

EA

Sunset Park Family Health Center 150 55th Street Brooklyn NY 11220 AEGD Residents

Morris Heights Health Center 85 W Burnside Avenue Bronx, NY 10453 AEGD Residents

Callen Lorde Community Health Center 356 W 18 Street New York, NY 10011 AEGD Residents

Bedford-Stuyvesant Family Health Center 1413 Fulton Street Brooklyn, NY 11216 AEGD Residents

Joseph P Addabbo Family Health Center 67 Rockaway Beach Blve. Arverne, NY 11692 AEGD Residents

Brooklyn Chinese Family Health Center 812 54th Street Brooklyn, NY 11220 AEGD Residents

Park Ridge Family Health Center 6317 4th Avenue Brooklyn, NY 11220 AEGD Residents

Peekskill/Hudson River Health Center 1037 Main Street Peekskill, NY 10566 AEGD Residents

CA

PIT

AL D

ISTR

ICT U

PS

TA

TE N

Y

Schenectady FHS 602 Craig St. Schenectady, NY 12307 AEGD Residents

1st Advantage Dental 1202 Troy, Schenectady Rd, Latham, NY 12110 AEGD Residents

Whitney Young FHC Lark Dr. & Arbor Dr. Albany, NY 12210 AEGD Residents

PR

OV

IDEN

CE R

HO

DE I

SLA

ND

St. Joseph Hospital 21 Peace Street Providence, RI Pediatric Residency Program

TENNESSEE

Implementing an LMC Program Implementing an LMC Program at a Clinical Training Siteat a Clinical Training Site

Site complies with ADA standards & program Site complies with ADA standards & program curriculum, including but not limited to:curriculum, including but not limited to:

Identify dentists who will provide clinical supervision of Identify dentists who will provide clinical supervision of residentsresidents

Provide practice resources (auxiliaries, supplies, room, Provide practice resources (auxiliaries, supplies, room, etc.)etc.)

Provide the required clinical experiences*Provide the required clinical experiences* Evaluate clinical competency**Evaluate clinical competency** Provide support for didactic curriculum (resident Provide support for didactic curriculum (resident

schedule, cases, internet access, work space, etc.)schedule, cases, internet access, work space, etc.) Include resident in QA program (chart audits, meetings, Include resident in QA program (chart audits, meetings,

etc.)etc.)Sites can collaborate together to share resident(s) or Sites can collaborate together to share resident(s) or

provide additional rotations/experiencesprovide additional rotations/experiences

*Required Clinical Experiences*Required Clinical Experiences

Comprehensive Comprehensive multidisciplinary dental multidisciplinary dental carecare

Patient assessment and Patient assessment and diagnosisdiagnosis

Obtaining informed consentObtaining informed consent Promoting disease Promoting disease

preventionprevention Control of pain & anxiety Control of pain & anxiety

(behavior & (behavior & pharmacological)pharmacological)

Restoration of teeth Restoration of teeth (including single crowns)(including single crowns)

Replacement of teeth Replacement of teeth (fixed partial dentures, (fixed partial dentures, removable partial dentures removable partial dentures and complete denturesand complete dentures

Periodontal therapy Periodontal therapy (including surgery)(including surgery)

Endodontic therapy Endodontic therapy (including molar endo)(including molar endo)

Hard and soft tissue Hard and soft tissue surgerysurgery

Management of medical Management of medical and dental emergenciesand dental emergencies

Medical risk assessmentMedical risk assessment

**Online Evaluation/Outcomes **Online Evaluation/Outcomes Assessment ApplicationsAssessment Applications

Didactic CurriculumDidactic Curriculum

Provided by LMCProvided by LMCApplications of distance learning Applications of distance learning

within post doctoral dental education within post doctoral dental education Synchronous Learning via Synchronous Learning via

Video teleconferencing Video teleconferencingAsynchronous Learning via web-based Asynchronous Learning via web-based

applicationsapplicationsRegional EducationRegional Education

Growth of distance learning via Growth of distance learning via

video teleconferencingvideo teleconferencing

1994 1994 20 residents, 2 didactic sites20 residents, 2 didactic sites

(14 years later)(14 years later)

20082008118 residents, 24 didactic sites, 64 CHCs118 residents, 24 didactic sites, 64 CHCs

Requirements for Distance LearningRequirements for Distance Learning

Identify a didactic site for the region or islandsIdentify a didactic site for the region or islandsPurchase equipment or utilize a local network Purchase equipment or utilize a local network

sitesiteLMC uses a bridging service – ExpediteLMC uses a bridging service – ExpediteExpediteExpedite

Performs test calls with new didactic sitePerforms test calls with new didactic siteConnects all sites for VTC sessionsConnects all sites for VTC sessions

Weekly confirmation of connection timesWeekly confirmation of connection timesFacilitator – one or more dentists at each didactic Facilitator – one or more dentists at each didactic

site for weekly didactic sessions (assistant site for weekly didactic sessions (assistant director + site faculty)director + site faculty)

Video Teleconferencing Sites

Honolulu HIHonolulu HITucson AZTucson AZ

Winslow AZWinslow AZ

Ocala FLOcala FL

Albany NYAlbany NYBrooklyn NYBrooklyn NY

Providence Providence RIRI

Boston MABoston MA

Alamosa COAlamosa CO

Maui HIMaui HI

Anchorage AKAnchorage AK

Memphis TNMemphis TN

Keaau HIKeaau HI

Bethel AKBethel AK

Juneau, AKJuneau, AK

Eastern Eastern Shore MDShore MD

Holyoke MAHolyoke MA

Meridian MSMeridian MSGallup NMGallup NM

Mesa AZMesa AZ

Jackson MIJackson MI

Oakland CAOakland CA

Redding CARedding CA

San Juan PRSan Juan PR

Columbia University School of Dental Medicine AT Still University/ ASDOH University of the Pacific Boston University University of Arizona Northern Arizona University University of Rochester/ Eastman Dental Center University of Missouri – Kansas City Hawaii Primary Care Association Penn State University – Hershey Idaho State University – Pocatello New York State OMRDD Marquette University Kaiser-Permanente Syracuse Medical Center

Telecommunication NetworkTelecommunication Network

Typical Week of a ResidentTypical Week of a Resident

MONDAYMONDAY TUESDAYTUESDAY WEDNESDAYWEDNESDAY THURSDAYTHURSDAY FRIDAYFRIDAY

CLINICCLINIC

ALL ALL DAYDAY

AMAMCLINICCLINIC

1–5 PM – VTC/1–5 PM – VTC/DIDACTICSDIDACTICS

CLINICCLINIC

ALL ALL DAYDAY

CLINICCLINIC

ALL ALL DAYDAY

CLINICCLINIC

ALL ALL DAYDAY

Resident assignment to Saturday sessions are permitted with faculty supervision.

Creative scheduling allowed providing there’s supervision and resident has minimum 40 hours devoted to the entire program.

VTC based on EST; therefore allow for different starting times in other time zones – lecture may start in AM session

ConclusionConclusion

These pivotal elements describe how These pivotal elements describe how vision, health policy, innovative ideas, vision, health policy, innovative ideas, can be translated to a major workforce can be translated to a major workforce program that increases access to program that increases access to services for the underserved, while services for the underserved, while maintaining an educational commitment maintaining an educational commitment to equity and service learning in to equity and service learning in postdoctoral education.postdoctoral education.

ContactsContacts

Susan Dietrich, DDSSusan Dietrich, DDS

Director, Graduate Dental EducationDirector, Graduate Dental Education

Phone: 646. 413. 8846Phone: 646. 413. 8846

Email: Email: sue.dietrich@gmail.comsue.dietrich@gmail.com

Anna D’ Emilio, DDSAnna D’ Emilio, DDS

Director, AEGD ProgramDirector, AEGD Program

Phone: 718. 630. 7213Phone: 718. 630. 7213

Email: Email: ademilio@lmcmc.comademilio@lmcmc.com