Community rotation helps students address their hidden bias

A faculty member in blue scrubs instructs a group of dental students who are gowned up and ready for patient care.
Vidal G. Balderas, DDS, MPH, director of the Primary Dental Care Program Rotation for the Homeless, discusses patient cases with students at Haven for Hope.


UT Health San Antonio has remained committed to combating health care disparities in San Antonio and South Texas by expanding access to health care services for all vulnerable patient populations.

However, even with equality as a top priority for many health care professionals, addressing one’s personal bias remains a crucial part of preventing unnecessary barriers to patient care, said Vidal Balderas, DDS, MPH, an associate professor of comprehensive dentistry in the School of Dentistry.

These biases refer to the hidden beliefs and attitudes all people have that influence how they respond toward others.

“All of us, whether we are aware or not, carry biases,” Balderas said. “The provider and patient are no exception, so if they are not taken into consideration and addressed, they could potentially be a contributor for inequitable care.”

Balderas directs a community-based rotation at the San Antonio Christian Dental Clinic within Haven for Hope. On a weekly basis, dental and dental hygiene students provide care to individuals experiencing homelessness and to low-income San Antonians who lack dental insurance and the money to see a private dentist. The patient pool includes all demographics, many of whom struggle with substance abuse, mental health or have been victims of domestic violence.

One clear objective of the rotation is to challenge student providers to face and reflect on their own hidden biases.

“Assumptions about others negatively impact communication between a provider and their patient,” Balderas said. “When formulating a treatment plan, unjust assumptions could interfere with the best care possible.”

Experience in community-based clinics offers students the opportunity to care for individuals from all walks of life. They are able to sharpen their active listening skills, learn a range of cultural and social factors influencing health and understand how to care for patients with complex physical, psychological or social needs, according to Balderas.

The effectiveness of these experiences is assessed through guided reflections at the end of the rotation. Students are asked provide feedback including what was most impactful about their week.

“My initial impression was that I was a little intimidated by the environment as I have not spent much time in this part of town. This impression did change over the course of the rotation. I had a patient who made me realize that we need to treat everybody with respect and be sympathetic. This patient was so grateful that we could see him and treat his dental pain. Throughout the entire procedure he was just so appreciative of the time that we were giving him that it really made me somewhat sad; that he may have experienced being overlooked in his life. It was important to me because it made me more sympathetic towards this population group.” – Anonymous student feedback

“The vast majority of students are positively surprised by their experience and appreciative about participating in this rotation,” Balderas said. “Facing our hidden biases is a necessary step toward health care equality.”

Test yourself for hidden bias using “Project Implicit”, a test created by psychologists at Harvard University, the University of Virginia and the University of Washington.

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