Current literature collectively confirms the importance of CSL and the benefit of experiential clinical learning curriculum on the attitudes and knowledge of learners participating in such outreach initiatives; however, there remains a scarcity of literature related to the integration of CSL within a global context into undergraduate dental curriculum. The study described here is novel in its exploration of the experiences and impact of GHCSL among undergraduate learners through the utilization of reflective essays. We found five overarching themes that intersect and/or compile the experiences of the learners while carrying out their GHCSL placements. Similar to other studies, the results of this study collectively demonstrated significant improvements in cultural humility, knowledge, and attitudes among the learners.
Reflections revealed that these improvements were influenced by the learner’s experiences of being exposed to a breadth of “real-life” clinical experiences that would not typically be observed in their local community or institution’s clinic. Studies have revealed that experiential learning from “real-life” clinical experiences is an essential component in understanding local community and cultural contexts, as well as developing the learner’s competence, confidence, and preparedness in providing care to patients with diverse condition presentations, cultural backgrounds, and socioeconomic barriers, as confirmed in our results (Angelopoulou & Kavvadia, 2018; Sng et al., 2023; Khiatani et al., 2023; Bahammam & Bahammam, 2023). As such, Truong et al. (2023) suggests that this experience may foster a broader perspective on global oral health disparities among the learners, encouraging them to advocate for oral health equity and gain a desire to seek solutions that address these disparities throughout their careers as oral health providers (Truong et al., 2023).
Emphasis was placed by the learners on their emerging understanding of the nature and challenges presented by culturally diverse patient populations as they integrated themselves socially in both the local language and culture. Previous studies have recognized CSL as an excellent pedagogy for providing learners with the opportunity to not only gain awareness of cultural and healthcare issues but also encourages the development of cultural competence through social integration (Amerson, 2010; Klenner et al., 2022; de Leon, 2014; Garcia et al., 2008). Social integration providers learners with the experiences necessary for developing cultural awareness, sensitivity, knowledge, and skills, while also diminishing their explicit and implicit biases toward other cultures (Chen et al., 2012; Nair & Adetayo, 2019; Bazargan & Cobb, 2021). Such experiences have been deemed as prerequisites by Garcia et al. (2008) for the implementation of culturally competent care and effective patient-provide communication—both of which are integral to building trust between patients and providers (Choy & Ismail, 2017).
While reflecting on the experiences of access to care among patient populations, the learners made note of the contrasting healthcare systems in Canada and their placements. Immersing themselves within local healthcare systems helped the learners understand the adverse impact resource constraints have on the dissemination of care and the need to implement creative innovations to circumvent challenges that would not be possible otherwise (Lyng et al., 2021; Ojo et al., 2021). The study by Oje et al. (2021) went on to report that there is an opportunity for reverse innovation, which refers to the transferring of strategies adapted first in resource-limited countries such as Uganda to resource abundant countries like Canada. This conscientious mindset forces adaptation and the adoption of sustainable practices, which the learners may consider instilling as they transition into treating patients in their local community (Oje et al., 2021). The prevalence of local endemic conditions such as HIV infection, along with the experience of HIV-related stigma was also reflected on by the learners. Given that people living with HIV are often stigmatized by their oral health providers and often face high unmet oral healthcare need, it is important to expose learners to vulnerable populations as it provides an opportunity to understand the benefits associated with diminishing misconceptions about conditions such as HIV and provide culturally safe care (Vitsupakorn et al., 2023; Donnelly et al., 2016; Jessani et al., 2019; Jessani et al., 2021; Shah et al., 2014).
The exposure to global oral health disparities garnered numerous affirmations by the learners, with many reflecting on their motivation and dedication to engage in future outreach initiatives after graduation. Previous studies have revealed that CSL—whether in a local or global context—exemplifies an approach that greatly improve learners’ awareness to community oral health needs, positively impacting their attitude towards community service and willingness to provide care to underserved populations as part of the community service (Coe et al., 2015; Bahammam & Bahammam, 2023; Anand et al., 2017; Volvovsky et al., 2014). Similarly, in a study by Smith et al. (2006), a positive relationship was reported between learners who agreed that their dental education provided them with the opportunity to treat patients from diverse socioeconomic and cultural backgrounds and the learners’ intentions to treat these patients. This insight confirms the findings of this study, as the impact outreach experiences have on learners’ awareness of the oral health needs of a community often translates into a desire to fulfill such need through community service.
Personal and professional growth was largely emphasized by the learners in their reflective essays.
Consensus was made throughout the literature regarding the importance of experiential community service learning for learners’ professional growth as it provides them an opportunity to gain a better understanding of barriers to care and follow a patient-centered care model (Tiwari et al., 2020). Such insight is suggested to be linked with personal growth, encouraging the development of future oral health providers who have the interpersonal skills necessary to provide individualized, high-standard care to patients (Bahammam & Bahammam, 2023).
The themes uncovered in the learners’ reflective essays were largely interconnected and did not appear to stand in isolation. Engaging with diverse communities, being exposed to unique patient cases, and witnessing the adaptability exuded in resource-constrained environments presented the learners with the desire to understand and mitigate global oral health disparities. The learner’s social integration and heightened awareness of the contrasting healthcare systems in Canada and their placements sites encouraged the development of a not only empathy, communication, and compassion skills, but a deepened understanding of the high unmet oral healthcare need and HIV prevalence in resource-constrained communities among the learners.
Limitations
This study has several limitations. Given that the data collected is qualitative, its interpretation is considered inherently subjective. Although steps were taken to reduce individual interpretative biases—with the inclusion of multiple researchers analyzing the data and themes chosen based on recurrence—the slight potential that subjectively may still exist is still present. Additionally, only a small number of learners were enrolled in the GHCSL program and only two sites in East African were visited; therefore, the insights obtained may not completely represent the experiences of all learners at Schulich Dentistry and may not reflect the experiences that learners may have had if given the opportunity to attend placement sites in other East African countries. Nevertheless, this study captured detailed experiences of the learners participating in the GHCSL placements in East Africa, a focus not extensively researched.