Win-Win With An IHS Externship!

This past August, six students from the University of Medicine and Dentistry of New Jersey (UMDNJ) took part in an Indian Health Service (IHS) externship sponsored by the OKU-Omega Omega Scholarship Foundation. Accompanied by Gary Vitaletti, DMD, MA and James Delahanty, DMD, EDM, the students traveled to the IHS dental clinic on the Pine Ridge Indian Reservation in South Dakota. The students, working under the supervision of CAPT Jose Rodriguez, DDS, Chief, Service Unit Dental Program at Pine Ridge Indian Hospital, performed close to 90 procedures — improving their clinical skills and gaining new confidence in their abilities as dentists. As Drs. Rodriguez and Vitaletti tell it, the externship was a very worthwhile and unique experience — a win-win for all.

Q: This externship was a unique opportunity for the students at UMDNJ, what did you want the students to accomplish during the externship?

Vitaletti: My expectations for the externship and for the students were essentially to expand their multicultural horizons, to deliver care to an underserved population, and to help expand their own particular clinical skills. At this stage of dental experience, students have only treated patients for a matter of months. They may not know if they want to go into a certain clinical discipline such as endodontics, orthodontics or periodontics. Generally, they're still undecided as to what they want to do. The externship gives them an opportunity to look in different directions and see if this might be for them.

Rodriguez: Students come from various dental schools and do a two week long externship. During that time at Pine Ridge, we expose them to public health dentistry and some pediatric dentistry. We guide them in what the needs are of the Native American population and compare that with what they're learning in school. This past year, we had about 23 student externs this year — which I think is a record for us. That includes dental students as well as dental hygiene students.

Q: How does the clinical experience of an externship compare to a student's school experience?

Rodriguez: When students are in dental school they're limited to probably two, three patients throughout the whole day. Here they start slow with one or two patients a day, two days later they're up to three or four, and by the end of the two week period they're seeing up to eight patients.

Vitaletti: At this point in their careers, the students have probably done one or perhaps several of a specific procedure — one type of filling or perhaps a crown or a bridge or a denture or two. So every single additional procedure they do is another milestone or plateau both in their data bank of dental knowledge as well as in their manual skills. It almost exponentially multiplies their clinical experience.

The types of procedures at Pine Ridge were very similar to what our students have been doing for the prior year as junior dental students — routine types of fillings and extractions. They also did some root canals and several surgical extractions which were fairly complicated.

Rodriguez: During the externship, students are going to be exposed to do a lot of operative procedures, fillings of different types, extractions and they also do some endodontic procedures. At Pine Ridge, the externs get more hands-on with pediatric dentistry, especially with patients going to the OR. They can join one of our pediatric dentists in the operating room and watch a complete dental rehab on the child and see how we approach it.

Vitaletti: I think they were able to accomplish more; they certainly didn't back down from any of the procedures that were given. We had patients coming in with mouths that were severely devastated by dental disease such as decay and/or gum problems. Our students were somewhat accustomed to such disabilities from their experience treating patients from a largely poor urban area such as Newark.

Q: Is an externship enough time for students to see real progress in their skills?

Rodriguez: One of things that many students don't realize is how much they can do. By the end of their first week, students see that they got to do quite a few procedures in one day, which normally would have taken a whole week in school. In the school setting there are often a lot of stops and checks that slow down the process. Treating a large number of patients is something they just don't get to experience in school.

The one thing I tell students right off the bat during orientation is that they should expect to see their self confidence in providing clinical care go up. They'll become much faster doing procedures and their clinical thinking will click. I see that when they come and discuss their cases with us and they're very assertive in their thinking. It gives them a sense of self confidence that, yes, I can do this. They just blossom toward the end and that's when I wish we had a couple more weeks so they could really reach their full potential.

Vitaletti: Given the students' experience level, each one averaged 15 to 20 patients of various types, degrees and complexities, all of which was beneficial to their education. During the time we were at Pine Ridge, the students did close to 80 to 90 procedures among the six of them. Working on that number of patients in a short period of time makes them much more confident.

Rodriguez: We do work with them and watch over their shoulders, just to avoid them falling into pitfalls. All the dentists in the facility communicate what our findings are, how well they are doing so the externs can advance into doing more procedures or see more patients. If we see something that needs our attention, we just step in.

Q: The IHS facility at Pine Ridge is in a rural area of the country — most might consider it remote. Are students surprised by the location?

Vitaletti: We stayed in Gordon, Nebraska and the clinic is 17 or 18 miles from the Nebraska border so it was about a 35 mile trip to Pine Ridge which passed much faster than a similar trip in the New Jersey area. For the students, the remote location underscored the fact that things aren't always at their fingertips the way they may be in Newark or New York or Washington DC where they can just make a phone call to a specialist down the street and have a problem answered.

I think it was a wake up call for them, in their experience, to understand that they're kind of out there as the "country doctor" so to speak, and they have to be able to do more things and wear more hats. That was a big part of their learning as well.

Rodriguez: Often students will ask, "Can I just get a taxi and get dropped down at your place?" Until they come out here, many of them don't understand what a remote location is. And it's kind of surprising when they fly into an airport, that's a second level airport, like Rapid City. Then they have to drive for two hours in the middle of nowhere to find this place. And there's nothing in between, so it's a culture shock.

Q: Given the location of the facility, what can externs plan to do in their spare time?

Rodriguez: One of the pluses for students that come out here during the summer is it's a great opportunity to delve into the cultural aspect of the community. We encourage them to go to the pow wows, to get out and learn more about a culture that's different from their own. In addition to that, there's a lot of sightseeing to do, and Pine Ridge is close to some of the national parks.

In terms of recreational activities, we've have outdoor activities year 'round — hunting, fishing, skiing, you name it, you can do it within a two hour drive of Pine Ridge.

Vitaletti: We were going out to an area of the country that I'm sure none of them had been to before. That area of South Dakota is beautiful and certainly relatively desolate to where we are in the urban northeast — everything seems to be 100 miles away. We stopped to see Mount Rushmore on the way to Pine Ridge from the airport. Had I known what I know now, I probably would have planned a few more personal days at each end of the externship so they could have done more sightseeing and developed a broader sense of the surrounding area and the cultural experiences available.

Q: Beyond increasing techniques and skills, are there other advantages of participating in an externship?

Vitaletti: Dentistry has historically been considered a cottage type of industry. I've been teaching and in clinical practice for 33 years. In that time I have seen both an explosion of technology as well as a paradigm shift in the direction of the profession and how it has evolved for students in terms of learning. There's certainly been a sense of global awareness in education for them. Dental school itself can tend to be very insular.

I think an externship of this type gives students an opportunity to look at different career professional opportunities and see if something like the IHS might be for them. For students still unsure of what they want to do after graduation in 2006, this certainly was an opportunity to expand their horizons.

Rodriguez: One of things I enjoy is the interaction with students. It's a two way street — they're here to learn from us, but at the same time we are learning from them what's being taught in schools. I can't even count how many different dental schools or dental hygiene programs we've dealt with throughout the years and each school has a unique approach to certain techniques or procedures. We get to hear about those differences through the students and it's interesting to learn from that.

Vitaletti: It's been a win-win-win situation for everyone. The amount of positive feedback from everyone has greatly exceeded the expectations originally anticipated for the students, myself and Dr. Delahanty.

I was most pleased with the way we were accepted and how the patients seemed to be very happy with the treatment that they received from the students. The students returned tremendously enthused about the program and would do it again if possible.

Q: What advice do you have for students that are considering an externship with the Indian Health Service?

Rodriguez: I think the most crucial thing for a student who is interested in doing an IHS externship is to plan ahead. Find places ahead of time because a lot of students sign up to the externship program and unfortunately there are a limited number of slots available. I wish we could give everybody that experience, but we just can't.

Vitaletti: I would say that it could be a once-in-a-lifetime experience, not just to increase clinical skills, but much more importantly to gain an understanding of a culture and a population that is generally considered underserved. Even if a student didn't go into this type of service, certainly he or she would gain on many cultural, social and clinical levels.

Ready for a career with Opportunity, Adventure and Purpose? Visit: www.dentist.ihs.gov/jobopps.cfm
or email to:
DentalJobs@ihs.gov

For more information about IHS Division of Oral Health, visit:
www.dentist.ihs.gov
Or Contact:
Timothy L. Lozon, DDS
Timothy.Lozon@ihs.gov
1-800-IHS-DENT (447-3368) or 301-443-0029 (direct)