This article represents a prologue of the discussion of the article “Models of DEIB: Part II–Exploring Models of Inclusion from other Health Professions for Dentistry”. It explores existing practices and philosophies from other disciplines that could be applied toward creating environments of inclusion and belonging in dentistry. The primary focus here is to provide an opportunity for the dental profession to leverage knowledge and experiences from other health professions to enhance and expand inclusion efforts and provide enhance engagement at all levels.
Key points
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Dentistry has had marked changes in education, practice standards, research, and societal norms, with this transformation strongly impacted by technologic advances such as improved materials, advances in technology, digital imaging, and minimally invasive dental techniques.
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Dental education and the profession continue to be challenged with adequately addressing oral health disparities.
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Embracing inclusivity across the broader spectrum of dentistry and the health professions provides an opportunity to help create more parity and better oral health outcomes especially for marginalized populations.
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Diverse voices make for more enriching environments creating spaces for innovation, collaboration, and safety; perhaps other professions working with dentistry and leveraging evidence-based practices can assist with building more inclusivity across the dental profession.
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Dentists benefit from working with allied and other health professionals who each contribute their specialized knowledge and skills to effectively advance inclusion and belonging for and within the profession.
Introduction
Dentistry has evolved over time from a technical trade to a recognized health profession. The journey has been significant and marked by various changes in education, practice standards, research, and societal norms. This transformation has been impacted by technologic advances such as improved materials, advances in technology, digital imaging, and minimally invasive dental techniques. A better understanding of the relationship between oral and systemic health has helped to move the profession toward a more holistic approach to oral health care. Additionally, the expansion of interprofessional education (IPE) has broadened the scope of dentistry to encompass not just preventive oral health care but collaboration with other health care professionals to promote well-being and better overall health outcomes. While the incorporation of these areas into training and care delivery have been transformational for majority populations, dentistry as a profession has not been successful in closing substantial gaps in dental education, research, and care seen in more diverse and inclusive environments necessary to eliminate oral health disparities.
Poor oral health is often used as a measure of social inequity. The uneven distribution and challenges faced across the populations are closely aligned with lack of access and resources in underserved and rural communities. A variety of changes are needed to address the disparities that include resource allocation, social and public health policy, community organizations, access to dental care, and behaviors reflecting inclusion related to cooperation of individuals and dental professionals. The history of dental education and the profession add challenges for addressing oral health disparities. Through embracing inclusivity across the broader spectrum of dentistry, an opportunity is created for more parity and better oral health outcomes especially for marginalized populations. Dentistry is not without concerted effort focused on helping to shift this paradigm. Since the late 1970s, dental schools and dental professional organizations have developed and implemented programs aimed at creating the composition of students, faculty, researchers, and practitioners with the commitment to promote diversity, equity, inclusion and belonging (DEIB) within the profession.
The commitment to these efforts, however, has not been comparable across all programs and organizations, yielding less-than-optimal results. Furthermore, in 2024 a reversal in this trend of support has resulted in divestment of resources for diversity, equity, and inclusion (DEI) programming within certain states, especially their state-funded educational institutions and programs, which include dental schools. In the mist of this backward shift, it is imperative that a collective focus be held on the importance of health equity and social justice to oral health, which supports building of a dental workforce reflective of the communities served. Expanding efforts to embrace inclusivity across the dental profession requires collaborative efforts, not just within the profession but in conjunction with colleagues across the health professions.
This article explores approaches from other disciplines toward consideration of applications to creating inclusive and belonging environments in dentistry. The primary focus is on the opportunity for the dental professional to leverage content utilized by other health professions to enhance and expand inclusion efforts, and provide better experiences for learners, researchers, educators, and patients within dentistry. Examples are provided of activities, frameworks, and models that are portable and can serve to launch similar activities within dentistry. Selected models of inclusion covered in Part II of Models of DEIB from library science, medicine, nursing, dental hygiene, and social work can be used by the dental profession to help make more definitive strides toward inclusion to combat lack of access and inequitable oral health outcomes.
Interprofessional Education
IPE has become the standard in educating health professionals across disciplines to improve patient safety and better health outcomes. Building highly effective health care teams is essential to delivering high-quality, safe, and patient-centered care.
Fostering collaboration, communication, and mutual respect among team members can optimize outcomes, enhance satisfaction, and promote a culture of excellence and continuous improvement in healthcare delivery. The utilization of the tenets of IPE enhances inclusion through promoting collaboration, mutual respect, and understanding among healthcare professionals taking into consideration the many backgrounds and life experiences of practitioners and patients. IPE has also become a standard across curricula of health professional schools with competencies embedded across different disciplines.
The Interprofessional Education Collaborative (IPEC) emerged in 2009 as a result of the interest of six national education associations for health professions in advancing interprofessional learning across disciplines based on the premise that building high functioning health care teams was important to improve patient and population health outcomes. The professions initially participating included allopathic and osteopathic medicine, dentistry, nursing, pharmacy, and public health, now there are 21e affiliate health organizations. The panel, after forming, developed recommendations for competencies that help guide curriculum development to ensure proficiency required for this collaborative practice model ( Box 1 ). Version three of the competencies (released in 2023) builds on the original work and framework recognizing variability across learners and institutions, refines competencies, and integrates concepts of the triple and quadruple aims. The IPE model of training is a good example of how people from diverse backgrounds, different professions, levels of experiences, and interests can work together in a way that is meaningful and inclusive to realize better results.
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Values and Ethics–Work with team members to maintain a climate of shared values, ethical conduct, and mutual respect.
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Roles and Responsibilities–Use the knowledge of one’s own role and team members’ expertise to address individual and population health outcomes.
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Communication–Communicate in a responsive, responsible, respectful, and compassionate manner with team members.
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Teams and Teamwork–Apply values and principles of the science of teamwork to adapt one’s own role in a variety of team settings.
Library sciences
At Your Service
Cultural “competence” and cultural humility are parts of the health sciences disciplines with much of the research conducted within the medicine and education fields. Librarians and archivists are a part of a larger ecosystem of public service, which parallels dentistry in the mission of service to community. One might attest that librarians play a part in the overall mental acuity and health of community members by providing resources for learning and educational growth: not only in intellectual pursuits and entertainment, but also entrepreneurship and wealth management, creative exploration and expression, and providing space for group gatherings, economic resources and public platforms.
When librarians think about “inclusion,” it is difficult to separate it from their responsibility to be accountable and aware of the wide array of diversity needs across collective populations. Diversity includes, but is not limited to, age, ethnicity, neurobiologic variations, disabilities, and various levels of intellectual capabilities. However, inclusion is much more expansive in scope. Inclusion encompasses not only external community, but also internal community and the tools and resources are available. Inclusion means to be a part of, belong to, and actively contribute to an ecosystem’s growth and evolution. Inclusion also implies looking at not only diverse viewpoints and perspectives but also at how to apply these principles in a way that everyone feels welcome, provided for, and above all, psychologically safe . According to Davis and colleagues :
“A library that actually serves everyone takes care to think deeply and expansively about its spaces, services, and offerings and iterates with an expansive and diverse library user population in mind. I’m talking fat weight-rated chairs, fragrance-free policies, dimmed spaces for light sensitivity, multilingual staff with pay differentials for those skills, meaningful and accessible interpretation services, support for remote work, and more.”
Using this approach, the dental profession can more effortlessly address the challenges associated with accommodating the many different types of learners, providers, patients, and staff that make up the care team that can come from very different backgrounds and experiences.
The field of libraries lives and works in parallel universes. Information is not just about what is available in the microcosmic world of books and digital information; it is also about how the tacit world and knowledge are absorbed as if by osmosis. To create inclusive environments, it is important to understand biases that may serve as barriers to achieving inclusion and belonging. Schrodinger’s Cat is used: to help look within the box to see how “set” practices might need to shift and evolve to include a larger view of reality. The concept has been studied in the health care setting and has called into question the potential biases associated with decision-making in patient care associated with potential care outcomes. , One must be aware of what is known and what is not known, and what is yet to be known but is a possibility. This deeper introspection is needed as an aid to unravel the mysteries still underlying our commitment to achieving diversity and inclusion across health professions.
But what does it mean to feel included? Inclusion can be somewhat amorphous in reality. Everyone comes from intergenerational programming: having learnt certain behaviors from family, passed down so subtly that the effects are not known until adulthood. These experiences, both positive and negative, can cause implicit biases that create blind spots and gaps in understanding. Everyone has a certain idea of what reality entails, what is and what is right and wrong . Even though to believe eventual wisdom will be gained, this wisdom is based on experiences and what is noticed or even chosen to be paid attention to during those experiences. Diverse environments help dilute and color the bicameral, black and white thinking of the mind. Diverse voices add value by opening doors to those well-worn neuropathways, an example is provided in the following vignette in Box 2 .
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Vignette
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“There was a poster in the library where I used to work advertising a book and how important it was for development. It had a quote “my eyes could see no further….” and then the image of a book specifying that indeed they can when you choose to read. The very basis for the library is to enhance ways of seeing, to provide intellectual stimulation and growth, and perhaps escape for some of us, into a new world, to experience things we had not before.” Feeling included means more than just feeling that the atmosphere of a building is calming and has suitable research space, or that the research collection we are viewing represents diverse voices, or even that our particular neurodiverse challenges have been assessed and accounted for in an online search engine.”
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In this vein, equity can manifest in various forms: physical, structural, and in terms of information clarity. The primary categoric structures modeling the movement toward social maturity are diversity, equity, inclusion, and social justice, truncated as diversity, equity, inclusion and justice, , suggests the need for a model for transformation of organizational cultures to become fully functional in practice and ready to move into the future. Library sciences also incorporate Diversity Equity Inclusion and Accessibility (DEIA) recommendations and suggestions—bringing long-standing policies up to date. Other ways that the library and archival fields have taken on the responsibility of being inclusive is to create international, national, and local strategic plans, vision statements, and initiatives that incorporate DEIA into the overall infrastructure and framework of the goals of the organization.
Key obligations and goals of any library organization is to provide information, with the ethical obligations of the American Library Association (ALA) being to ensure all voices are heard and listened to as expressed in the ALA ninth code of ethics ( Box 3 ).
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The ninth principle reads:
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“We affirm the inherent dignity and rights of every person. We work to recognize and dismantle systemic and individual biases; to confront inequity and oppression; to enhance diversity and inclusion; and to advance racial and social justice in our libraries, communities, profession, and associations through awareness, advocacy, education, collaboration, services, and allocation of resources and spaces.”
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Specifics vary, for example, Northwestern Libraries Strategic plan includes the statement to: “Outfit library physical and digital spaces with visuals that mirror the demographics on campus through use of collections, exhibits or static imagery. Assess and prioritize the processing of collections that document diverse voices. Review descriptive language in online records for misleading, non-inclusive and offensive terminology on an ongoing basis. [and]
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Identify funding sources to support the collection and processing of, as well as the outreach efforts related to, holdings that represent voices from historically marginalized groups.”
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Overall, the literature suggests that the movement must be a top tier effort supported by policy development and following a succinct strategic plan with equity as a focus. In practice, this must include outward movement into the community and a “cross pollination” of ideas, resources, and overall knowledge transfer. , , , The newest approaches move beyond the concept of “breaking down silos” into a rebuilding of community and a maturing of our overall organizational and environmental culture. In Darwinism, this approach is called “domestication.” One genetic study did a fascinating experiment on pack behavior in dogs, learning that once an internal culture developed of “domesticity” or “calmness” newly introduced members had no choice but to conform to the new and evolved pack.
Believing in the good —in the ability to adapt into kinder, more inclusive communities is on the rise, is learned that these methods work and, environments are created that people want to be a part of, with learning spaces that leave room for the “impossible” new thought or ways of experiencing and exploring history. Diverse voices provide a more enriching, beautiful tapestry of experiences. As a service profession librarians and archivists provide context, unaltered “truth” and a place for discovering whatever that means. Perhaps the start is not trying to identify a universal truth across all professions, but instead aiming at humility and identifying, however painful and shaming, historic and present accuracy.
Medicine
Points of Inclusion
The consideration of inclusiveness in medicine often focuses on situations or points of inclusion. Points of inclusion represent individual or person focused initiatives to ensure that people of all cultures and backgrounds are included in the organization. Inclusion follows diversity as diversity focuses on make-up of the people in the room, whereas inclusion focuses on engagement and contributions of people in the room, with a focus on interactions, team and collaboration. For purposes of the field of medicine, these people, or touchpoints of inclusion are defined in the broad categories of learners, faculty and staff, and senior leaders or administrators.
Learners
Learners are arguably the most important touchpoint for inclusion in academic health centers and in the field of medicine. Learners represent the future of care for a growingly diverse and aging population. Ensuring that diverse learners feel included in all aspects of their training, including having their cultures and backgrounds appreciated and their opinions heard and valued, is critical for learner growth and success. Learners in medicine can be defined as resident physicians, health professions students, graduate students, and medical students.
Opportunities to create inclusive environments are many for learners. Pathway programs are designed to do just that. These programs, often structured for marginalized or minoritized populations, can provide healthcare exposure and academic strengthening to the learner who were not afforded the opportunities or resources to maximize their learning and realize their potential because of systematic racism, community inequities, or socioeconomic concerns. Such programs, when structured appropriately with focused outcomes, can create inclusive environments and add diversity to the healthcare professional landscape. Similar to these programs, holistic admissions processes in medical education bring inclusion and equity to a process that previously have advantaged some and disadvantaged others. Holistic admission allows for inclusion of groups who are important to the care of underrepresented and minority populations and can improve health outcomes. Initiatives such as pathway programs and holistic admissions, while increasing the diversity of learners in medicine, are set up for creating inclusive environments for all learners to thrive and advance their education for the benefit of all patients.
Additional points of inclusion for learners include curricula that are developed from a culturally competent and culturally intelligent perspective. These curricula consider the backgrounds and socioeconomic status of the learner and how those variables impact the learner’s existence in the academic environment, and how equity is described in those environments to promote the success of all learners. These environments promote psychologic safety and inclusive excellence in a way that encourages the contributions and opinions of minoritized populations. In addition, mentorship programs focused on marginalized groups, and in particular cross-cultural mentoring programs, affinity groups, and support networks create an inclusive environment for learners promoting not only a diverse environment, but intersections in ways that can drive inclusive excellence.
Faculty and Staff
Inclusive excellence for faculty and staff members in medicine takes on a different approach than that of the learner. Faculty members tend to be long-term employees of the institution, with marginal turnover is marginal, maybe every four y or so. However, DEI efforts and efforts to promote an inclusive environment often receive limited attention. Importantly, academic environments must be inclusive, equitable, and nurturing to promote a collegial work culture that allows all to be successful and optimally productive. Part of creating this inclusion is through offices of faculty development. Increasing the skills of faculty and staff members who are marginalized or minoritized in medicine has the potential to increase their inclusion in the academic environment and their contributions across all missions of the institution. The setting of faculty development must be one of institutional equity in all areas of the academic environment, including areas such as education, clinical care, and research, along with identify focused development that considers impacts of culture and background. Other areas that impact inclusion are human resources (HR) and staff training. HR capture data on the makeup of the organization, to not only include training and degrees obtained, but also race/ethnicity and gender. By sharing the diversity makeup of the organization, HR gives a platform for inclusion for those who may be from marginalized or minoritized identities. Impacts of society-based initiatives or experiences such as minority physician focused organizations like the National Medical Association, the National Hispanic Medical Association, and the American Medical Women’s Association not only provide pathways to increase diversity, but provide platforms for inclusion for minoritized physicians, impacting their roles in the healthcare environment, including those who work for academic health centers. Many of these organizations have institutions focused on affinity groups or support networks that support their inclusion and belonging.
Environments of Inclusion
Health systems
Academic health systems require an understanding of the health system environment and those who work to effectively create an inclusive culture. These academic health systems are focused differently than the medical education environment, which centers primarily on the learner, curricula, and policies that govern and support education, the academic health system centers primarily on the patient, and require a broader and more structured approach to inclusion beyond but including learners, faculty, or staff. The focus on patients must appreciate how a patient’s culture and background impact medical decision-making and approach-to-care. This requires the healthcare team to consider cultural beliefs and non-traditional medicines or treatments for certain conditions in conjunction with the patient to make unique and inclusive treatment plans as appropriate.
Community affiliates and community partnerships
The integration of the academic health system or medical school environment within the community in which it resides is an important engagement for both the community and health system. Historically, academic health systems’ engagement consisted of gathering community data and creating community initiatives in the face of service; in some instances, to only have them eventually dismantled, leaving the community let down bringing forth concerns of racism and lack of trust. ,
Inclusion for community affiliates and community partnerships involves early and often engagement to build trust and relationships, such that academic health center leaders are present in the community and serve in ways to promote advancement of community goals. Community partnerships that are designed to be symbiotic with outcomes that evidence advancement on both fronts must exist. Excellence in inclusion includes dual representation on strategic planning, mission, and vision setting boards with key performance indicators and tangible outcomes that show a lasting impact on both the health system and the community.
Nursing
The American Association of Colleges of Nursing
The American Association of Colleges of Nursing (AACN) Diversity, Equity, and Inclusion Faculty Tool Kit defines inclusion as representing environmental and organizational cultures in which faculty, students, staff, and administrators with diverse characteristics thrive. Inclusive environments require intentionality and embrace differences, not merely tolerate them. Everyone works to ensure the perspectives and experiences of others are invited, welcomed, acknowledged, and respected in inclusive environments.” AACN , also defines belongingness as an effective state of engagement, one that heavily influences how people feel about themselves and others. Belongingness is a multifaceted and complex state of being that is heavily influenced by both internal and external factors. A students’ sense of belongingness and their engagement in academic study have been identified as key contributors to student success.
When examining sense of belonging in the classroom setting, two major players emerge: faculty and classmates. Faculty set the tone for student interactions and model respect and valuing. The extant literature shows that students with high levels of belonging speak to having had positive experiences with faculty who exhibit a caring disposition, use active learning techniques, and create safe spaces for expression and debate. Institutional viability and capacity are necessary to examine the nursing school’s infrastructure, allocation, and utilization of resources supporting alignment to build DEI capacity. Leadership, accountability, strategic planning, and metrics are key drivers of sustainability, excellence, transformation, and success. Access and Success provide nursing schools with opportunities to examine the structures, policies, practices, and attitudes to ensure access, retention, and success for all faculty, students, and staff. Access and success focus on access to nursing school, inclusion and belonging, and success of historically underrepresented and marginalized groups.
Fostering environments where diverse backgrounds are valued and respected is imperative for achieving mission-driven goals and commitments. Institutional Culture and Climate is critical to the experience of faculty, staff, and students, providing diverse, equitable, inclusive, and accessible environments where there is a collective sense of belonging and all individuals thrive and do their best work. Education and Scholarship are core competencies of nursing skills, reflecting faculty capacity, and pedagogical approaches that embody DEI. The structure of the processes determines the educational experiences of all students who are invited to participate in the learning environment. Fig. 1 provides a visual depiction of the Inclusive Excellence Ecosystem for Academic Nursing.
