Enhancing dental students' understanding of poverty through simulation

Dental students should develop an understanding of the barriers to and frustrations with accessing dental care and maintaining optimal oral health experienced by persons with limited resources rather than blaming the patient or caregiver. Developing this understanding may be aided by helping students learn about the lives of underserved and vulnerable patients they will encounter not only in extramural rotations, but throughout their careers. The aim of this study was to determine if dental students' understanding of daily challenges faced by families with low income changed as a result of a poverty simulation. In 2015 and 2016, an experiential poverty simulation was used to prepare third-year dental students at one U.S. dental school for their upcoming required community-based rotations. In 2015, United Way staff conducted the simulation using the Missouri Community Action Poverty Simulation (CAPS); in 2016, faculty members trained in CAPS conducted the simulation using a modified version of the tool. In the simulation, students were assigned to family units experiencing various types of hardship and were given specific identities for role-playing. A retrospective pretest and a posttest were used to assess change in levels of student understanding after the simulation. Students assessed their level of understanding in five domains: financial pressures, difficult choices, difficulties in improving one's situation, emotional stressors, and impact of community resources for those living in poverty. The survey response rates in 2015 and 2016 were 86% and 74%, respectively. For each of the five domains, students' understanding increased from 58% to 74% per domain. The majority reported that the exercise was very valuable or somewhat valuable (74% in 2015, 88% in 2016). This study found that a poverty simulation was effective in raising dental students' understanding of the challenges faced by low-income families. It also discovered that framing the issues in the context of accessing dental care was important.