Diversity and Inclusion: The importance of cultural competency training in dentistry

Many moons ago when I first arrived in the U.S., I was a double major in biology and music in piano performance at Fresno State, California. My piano professor, Dr. Werz, was newly emmigrated from Germany. He was serious and strict, nevertheless a very kind person.

Photo of Dr. Hung

Dr. Hung

Many of us under his teaching were foreign students. He would insist on calling us by our ethnic names, and he was one of the few who could pronounce my Chinese name correctly. He was a great mentor on various topics and an excellent professor. Knowing that I didn’t have any immediate family around, he helped me to find my first job in the U.S. — as a church pianist. He also asked me to babysit his newborn and toddler while he and his wife went out to dinner or to watch a show.

There were never any comments or assumptions about my culture. He would ask open-ended questions, and he was always respectful: he never used the word “girl” to describe me, and he never commented on how young I was.

Although I did not become a concert pianist, I remember Dr. Werz’s practice of professionalism and his practice of diversity and inclusion. He knew I was from Taiwan, and he was educated about the differences between China, Taiwan, Hong Kong and Malaysia. He never once lumped his Asian students together. He took notes on his students to make sure he got the facts right. He would make sure everyone was included in the conversation and favoritism was never observed.

When I discuss diversity and inclusion in the present day, I sometimes experience pushback on the topic or whether it is necessary to teach diversity and inclusion in school. I know of some people who feel that diversity and inclusion should not be taught in dental schools because it is not “dentally related”: just learn the technical part of dentistry. I also know some people who feel that diversity and inclusion is common sense. As a first generation immigrant living in the U.S. for 30 years, I strongly feel that diversity and inclusion is related to all professions, and that much work is required to develop to make our working culture more welcoming.

The curriculum for teaching students to learn about a diverse patient population is currently up to dental schools and not standardized. I am happy to see that more and more programs have diversity classes now in dental school programs. Students of different backgrounds must learn how to relate among themselves, to the faculty members, and to their future patients. A “colorblind” approach would not work because there is a deliberate effort to avoid looking at race and ethnicity. However, to truly employ diversity and inclusion, we must examine differences in race and ethnicity. Although gender and race are most discussed in the realm of diversity and inclusion, there are so many other facets such as religious beliefs, cultural beliefs, and personal beliefs, to name a few.

In my book “Pulling Wisdom: Filling the Gaps in Cross-Cultural Communication for Healthcare Professionals,” I introduce the concept of the “Amalgamation Scale” which categorize immigrants and their needs based on when they arrive to a new country (U.S.), socialization and language acquisition.

Many students, residents or practicing dentists may be first-generation immigrants with ethnic names which may be subjected to bias by their peers or patients. For example, patients may perceive a dentist with ethnic names to be less proficient in English or less capable. Dental school and residency programs can be the perfect time to develop strategies to improve rapport and understanding between dentists and patients of different origins.

A recent McKinsey and Company survey1 “pointed out that women, minority and LGBTQ+ still face additional challenges and more microaggressions at work.” Some of the examples listed in the article include not receiving credit for their ideas, needing to correct others’ assumptions about their personal life, hearing derogatory comments or jokes about people like them, being excluded from social events, receiving comments about the way they dress, and so forth.

Of those surveyed, they  experienced an average 11 events of microagressions per week.  If I were to translate these situations in a dental environment, these examples could very well be: women receiving uninvited comments about their clothing or being called “sweetie,” “honey,”  or “girl” by an older male colleague or even a older female staff member; “boat jokes” about Vietnamese colleagues who were refugees, or comments such as “when I graduated from dental school you are still in your diapers” from an older colleague to a younger colleague.

It is equally important to apply the principles of diversity and inclusion to your peers as well as your patients.

If your patient demographics are multicultural, I recommend researching their cultures, not just the general cultural values, but their mentality about health care.

For example, certain cultures may believe in alternative medicine and view certain procedures as unimportant and expensive. Some may view preventive pediatric dentistry as unimportant as “when baby teeth fall out there’s another set of teeth.” This is not necessarily cultures based on different country origins, but subcultures within the U.S.

An interesting study conducted by Case Western University2 to investigate Amish children’s oral care revealed that the Amish were more likely to tolerate pain without seeking for help as they lean to God as the ultimate healer, and that Amish parents may be less aware of their children’s oral health due to a lack of education. Certain genetic diseases, such as bleeding disorders, are more likely within Amish community due to marriage within a small community. A better understanding of Amish culture would help to educate and communicate with families in order to improve their health disparity.

Training for cultural competency is paramount to team success. Team members often make the first impressions, over the phone or in person. If your patient has long, ethnic names, ask how he or she likes to be addressed, and make a note in the account. Avoid gesturing patients with “summons”: palm facing up, wavering fingers.  Less English proficiency does not translate into less intelligence.

Team members should have basic ideas of “culture clusters”3, or cultures with similar beliefs and values by geographic regions.  The concept of culture clusters was proposed by Dr. David Livermore in his work about CQ, or cultural intelligence. Diversity and inclusion is not only dentally related, it is humanly related. In today’s world, hiring someone who speaks Spanish is no longer good enough. Understanding whether your coworker is from Mexico, Peru, Dominican Republic or Ecuador, is not only necessary to appreciate their value differences, but also to create a sense of belonging, which in turn, will increase teamwork performance and harmony in the workplace.

  1. Understanding organizational barriers to a more inclusive workplace. McKinsey & Company. June 23, 2020, Survey.
  2. Oral health and medical conditions among Amish children. Heima et. al. J Clin Exp Dent, 2017. 9(3): e338-43
  3. Livermore, David. Leading with Cultural Intelligence. The real Secret to Success. New York. American Management Association, 2015

Dr. Cathy Hung is a native of Taipei, Taiwan.  She earned a Bachelor of Arts in Psychology from University of California at Berkeley and a Doctor in Dental Surgery degree from Columbia University.  She further received oral and maxillofacial surgery training at Lincoln Medical and Mental Health Center, Bronx New York.  She is a Diplomate of American Board of Oral and Maxillofacial Surgeons. She is the owner of Prospect Oral Surgery Center in New Jersey, and is an author, speaker and coach on cultural competency for healthcare professionals. Her first book, “Pulling Wisdom: filling the gaps of cross-cultural communication for healthcare providers”, is now available in ADA bookstore as a practice management tool.  Dr. Hung is an advocate for diversity and inclusion and women leadership. She is an alumni of ADA’s Institute for Diversity in Leadership Program and a guest writer for ADA’s New Dentist Now blog and Dental Practice Success column. Her blog posts were recognized to be the “most popular blog posts of 2020” by ADA’s New Dentist Now blog.

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