Focusing on community needs and students' desires to
practice in rural and underserved areas, the University
of Washington School of Dentistry (UWSOD) created the RIDE
program, or Regional Initiatives in Dental Education.
The program, designed to provide students with the
knowledge, tools, and experience to make a rural practice
comfortable, is now placing over 70% of its graduates in
rural/underserved areas of Washington, as well as
California, Oregon, and Texas.
The 4-year program is modeled after UW Medicine's WWAMI
program, and strives for integration with it. For
first-year biomedical science instruction, WWAMI medical
and RIDE dental students both attend school at Spokane's
Eastern Washington University (EWU)
“hub” campus, sharing classes when
possible. RIDE students' second- and third-year training
occurs with their peers in Seattle. Overall, 40% of
RIDE's curriculum is delivered in the less populous
eastern part of Washington. In their fourth year, RIDE
students spend four months working with community health
center dentists. This training is intended to create a
“super-generalist” able to meet oral
health needs in rural and underserved areas.
In the early 1970s, the University of Washington created
medical education geared to serve patient needs in
communities throughout four states: Washington, Alaska,
Montana and Idaho. In 1996, Wyoming joined the
consortium. The program designation, “WWAMI,”
is built from participating states and has far-reaching
recognition for excellence in medical education.
The program, conceived in 2003 with original start-up
funding in 2007, was UWSOD's response to its university's
mission to serve all of Washington's residents, not just
those in urban areas, but also those who are underserved.
Dr. Art DiMarco, RIDE program director on site at Eastern
Washington University, said the RIDE curriculum designers
understood that student loan forgiveness hadn't proved a
dependable draw for rural placement.
“Loan repayment programs provide wonderful
incentives, but they don't attract as many students as
are needed, so we looked to UW Medicine's WWAMI
program,” DiMarco said. “Prior to
WWAMI, few students chose rural and underserved locations
in the Northwest. WWAMI has had a significant impact on
numbers of medical graduates who practice in such
communities. With our new RIDE program, we were aiming
for some of the same outcomes. But to have over 70%
locating in rural and underserved areas, that's an
But placement statistics indicate only part of the
program's success. Feedback from these communities also
helps tell RIDE's story. Dr. Robert Dillard, a RIDE
preceptor in Okanogan, Washington, said feedback comes to
his practice in two ways.
“My patients pat me on the back all the time
saying how happy they are that I'm part of the
program,” Dillard said. “They like
being part of the educational system.”
The second success marker, according to Dillard, is the
Patients are already calling at least once a day to get
scheduled with the RIDE student who's expected in a few
“Patients are already calling at least once a
day to get scheduled with the RIDE student who's expected
in a few months,” Dillard said.
Or perhaps program success is even better articulated by
a current RIDE student, Hayley Denison, in her fourth
“A lot of the patients I see have already seen
previous RIDE students,” Denison said.
“The patients actually seem to look forward to
our care. They have confidence in our decision-making.
Even if I see a patient who's not had a previous RIDE
student, they seem to know about us and don't question
seeing me. It's awesome that we seem to be very accepted
by the communities.”
RIDE Success: Identifying Curriculum Needs
Attracting students who want to help rural and
underserved communities. Seventy percent placement rate.
Evidence of community and patient satisfaction. What is
the backstory for this successful dental education model?
Anyone who talks about RIDE says its existence must be
credited to Dr. Wendy Mouradian. Eventually practicing in
rural Washington after a WWAMI pediatric residency
experience, Mouradian is a physician raised in New York
City and trained in New York and Boston. As RIDE's
founding director, she said her rural experience gave her
an up-close look at oral healthcare needs in rural and
“I understand the appeal of small towns and
rural areas,” Mouradian said. “Early
on I realized I wanted to take on a leadership role to do
something meaningful for these communities.”
Transitioning from her rural practice to a craniofacial
leadership position at Seattle Children's Hospital,
Mouradian next found herself working in the public policy
arena to help bring more dental care to areas in need.
She served as an advisor to the Health Services and
Resources Administration (HRSA) doing work on primary
care/oral health integration and worked at the National
Institute of Dental and Craniofacial Research.
But Mouradian is quick to share a comprehensive list of
funders, institutions, organizations, and individuals
that made the RIDE program a reality, from Washington's
state legislature, to university administration, to key
dental faculty and community preceptors. She highlights
the strategic leadership of DiMarco on the Spokane
campus, and Dr. Frank Roberts, current RIDE director who
has multiple UW appointments, including associate
professor and predoctoral program director in
Periodontics, Chief of Periodontics at the Seattle VA
Hospital, and interests in both the basic sciences and in
“The periodontist understands oral and systemic
connections and uses the same language as a
physician,” Mouradian said. “Frank
had a clear understanding of how dental and medical
students would benefit from the same education and how to
integrate with dental hygiene students as
Roberts said it was important for the RIDE curriculum to
coordinate with the UW medical curriculum because
cavities are not the only problems that dentists treat.
Mouth cancers, gum conditions, and jaw bone problems –
all part of routine dentistry – are impacted or even
driven by complex medical conditions. Understanding these
medical diseases then becomes important for dental
Rural or urban, the patients we're seeing in regular
dental clinics are now older — often even 95
years old — they have multiple medical
problems, they're in electric wheelchairs, have had three
different types of transplants, they have cancer, they
are living with chronic medical conditions.
“Our dental school education needs this medical
focus especially in the first two years,”
Roberts said. “Rural or urban, the patients
we're seeing in regular dental clinics are now older
— often even 95 years old —
they have multiple medical problems, they're in
electric wheelchairs, have had three different types of
transplants, they have cancer, they are living with
chronic medical conditions. The students really must have
a solid basic biomedical science foundation for their
dental training. This was the first thing we had to solve
with RIDE because that training occurs in their first
year of school, as it does for the medical students. Once
we had pulled that together on the Spokane campus, we
created a great program and I'm happiest about having
Though having no other experience for comparison,
fourth-year student Denison said she can't imagine having
a classroom experience without med students.
“The interaction with the med students is
fantastic — it's awesome,” Denison
said. “It's so cool to know that the first year
of dental school and the first year of medical school are
pretty identical. Commonly, people believe dentists don't
know much medicine, or even need to know as much medicine
as medical doctors. But out in practice, we're pretty
much on an equal playing field. Even today, I do medical
consults for my patients, I talk with my patients'
primary doctors and even their medical specialists.
Having that experience with medical students really
solidifies confidence for those conversations because we
have a common language. We are able to form relationships
readily with those doctors because we studied with med
Creating the Spokane Campus
Coordinating medical and dental curriculums happened on
EWU's Spokane campus. In addition to WWAMI, the RIDE
program critically intersects with the EWU dental hygiene
program, whose faculty assist in dental student training.
During the program's formation, DiMarco, an EWU professor
and both a RIDE administrative and clinical presence,
experienced many challenges moving the program forward.
The two most daunting? Infrastructure build and faculty
“In an environment not used to educating
dentists, there was limited space for RIDE on a campus
that was already very, very full,” DiMarco
said. “We needed compressed air and gas lines,
and a simulation lab. I met with an architect every two
weeks for a year and a half and finally got the right
design and permission to build the space we have
DiMarco said it was also not a simple matter to identify
all the faculty needed to teach the dental students.
A comparison is that dental schools graduate a
professional who will perform oral surgery in a time
frame of four years, compared to the medical path of a
surgeon, which might be twice as long. So, we go like the
wind. That means we have to have a lot of courses.
“Dental curriculum is more intense than the
medical curriculum in many ways,” DiMarco said.
“A comparison is that dental schools graduate a
professional who will perform oral surgery in a time
frame of four years, compared to the medical path of a
surgeon, which might be twice as long. So, we go like the
wind. That means we have to have a lot of courses. From
the traditional research fields like microbiology and
immunology, it can be difficult to recruit experts who
are interested in teaching the type of curriculum we
wanted for our RIDE students. Fortunately, I did have
contacts who were interested. And some dental faculty
actually moved from UW-Seattle to help us. It all worked
out and we have incredible faculty.”
RIDE Curriculum: Keys To Preparing the Rural/Underserved
Mouradian said another early step in curriculum design
was to think in terms of training the dental equivalent
of the family medicine physician, the key provider for
delivering medical care to rural and underserved
“We decided that the equivalent of a family
practitioner in dentistry would be a
'super-generalist,'” Mouradian said.
“So we created the curriculum needed to train a
competent general dentist able to handle the extra
difficulties that would be encountered in a rural
RIDE Curriculum Keys
Have faith in the students' desire to provide care
to rural/underserved populations and reward this
Ensure comprehensive training for rural practice.
Provide mentoring and post-graduation support.
Structure education for a “cohort
Acknowledging the important work of initial student
selection done by the admissions committee, Mouradian and
Roberts explain they believe they've identified four keys
to their placement record in training dentists to deliver
high-quality care to rural and underserved populations.
First, have faith in the students who express desire to
provide care in rural areas and hardwire a training
experience in those communities early in the curriculum.
For example, RIDE students complete a rural practice
experience their first summer. This is not just a
shadowing experience, as students show up with their
first-year regional anesthesia and other basic dental
skills, which allows them to help dentists at those
practice sites. Second, because confidence plays an
important role in students' final choice of practice
site, ensure they receive training in the advanced skill
sets needed to meet the challenges of rural practice.
Third, try to prevent or diminish the sense of isolation
that rural practitioners may experience by connecting
them to faculty mentors and community preceptors during
their student rotations and continuing these
relationships after graduation.
Roberts explains that a fourth and unexpected key
emerged: the “cohort effect.”
We thought about what we needed to do for their academic
and clinical training, not so much what they were going
to learn from each other. It's actually quite humbling to
see how much they get from each other.
“The first-year RIDE curriculum is probably
more demanding than the regular curriculum,”
Roberts said. “The students are there every
day. Nobody skips class. They support each other with
study groups, encouraging preparedness, preclinical work.
There's support to do well, and there's support when they
are having trouble, with studies or with life. They take
care of each other. When we created the curriculum, we
didn't think about that. We thought about what we needed
to do for their academic and clinical training, not so
much what they were going to learn from each other. It's
actually quite humbling to see how much they get from
From RIDE Graduates Come RIDE Preceptors
Dr. Camille Wahl, now practicing in Colville, Washington,
was one of RIDE's first graduates. Her first
practice site was in Coeur d'Alene, Idaho, where she
thought she'd be able to practice a broader set of
dentistry skills. In short order, she returned to the
rural practice setting “about an hour and a
half over the mountains from where I grew up.”
Wahl recalls her Colville interview three years ago.
Though she'd not done her RIDE rotations in Colville, she
knew it was a RIDE site. She asked if she'd be able to
“I got a 'yes' response to that question, and
right off the bat, I knew this is where I wanted to
be,” Wahl said, sharing that teaching was an
activity she was always involved with during her
undergraduate and graduate years.
“I come from a family of educators and I think
it's in my blood to teach,” Wahl said.
“When I get those RIDE students so eager to
learn, asking for feedback on those tiny little things
that make such a big difference in dentistry, it's really
rewarding. Especially seeing them grow and be ready for
practice. We hope they'll come back to us.”
As a preceptor, Wahl wants to replicate the RIDE training
she received that made such a difference, especially in
those first post-graduate months.
“When I first graduated, I'd talk to some of my
classmates. They were staying late. Their patients were
waiting. Me? I'd been pushed as a student. I had a jump
on time management,” Wahl said.
In addition to teaching, Wahl says she gains career
satisfaction from direct patient care of rural and
underserved patients, especially when using
“gentle dentistry” techniques to help
overcome dental phobia.
“I'd been taught that people show fear through
anger, so my first year here was difficult, dealing with
people who were so angry, but who were actually just
very, very afraid of the dentist,” Wahl said.
“People would yell, get mad. Now three years
later I hear, 'I've heard about you' and 'I wanted to
schedule with you.' They come back for that second,
third, or even fourth appointment some of them need. Word
is getting around about all the doctors here. Families
are not so afraid to come see us. We really make a
difference in oral health here.”
Another Curriculum Key: Passionate Preceptors
Mouradian and Roberts also point out the tremendous
impact of their preceptors' passion for providing oral
healthcare to rural and underserved populations. Back in
Okanogan, Dillard, also a UWSOD graduate, shares his path
to becoming a RIDE preceptor. He said he looks back on
his career that included military service, chief of
dentistry positions, working in several large Veterans
Health Administration facilities across the country, and
always teaching oral health students along with providing
direct patient care, a career track he describes as
“perhaps a bit cosmopolitan.” But, he
says he recognizes that significant career fulfillment
has come from these later years when he started working
in the public health arena. He said it was a profound
experience to connect with community health professionals
so committed to patients. Eventually finding himself back
in Washington in a rural area, “I called my
school to see if there was something I could help with.
Here I am, a RIDE preceptor.”
Are they acting as if this is just another mouth they are
looking in? Or are they approaching dental needs in
perspective, looking at the whole person? To do that over
and over again all day long is hard.
“My focus is to make sure the dental needs of
underserved patients are met,” Dillard said.
“That's where I come from, that's my driving
force since I came to community health. I've seen
students in many capacities over the years, so I know to
look at how they connect with patients. Are they acting
as if this is just another mouth they are looking in? Or
are they approaching dental needs in perspective, looking
at the whole person? To do that over and over again all
day long is hard. These RIDE students separate themselves
out by how they interact with patients. Each patient is
unique to them. Each patient's concern is important.
These students have a genuine, one-on-one concern for
patients and are very professional. These are the
experiences that make me come back to work every day to
With a perspective gained from many years as a physician practicing in rural and urban locations, Dr. Kay Miller Temple writes on a variety of rural health topics and programs for RHIhub's Rural Monitor and Models and Innovations. She has a master's degree in Journalism and Mass Communication. Full Biography