Dentistry, ethics and DEI: Catching up with Dr. Carlos Smith
Carlos Smith, D.D.S., M.Div., is director of diversity, equity and inclusion (DEI) and the ethics curriculum at VCU School of Dentistry. As a trained ethicist and student of history, he examines the context in which societal practices and institutions were constructed through a lens of equality and social justice. Often, he challenges his colleagues and students to examine the ways in which they interact with others as well as the patients they serve. At the school, he teaches a required ethics course in which he applies historical context to demonstrate how structural racism has led to health disparities and a lack of trust in health care institutions among minority communities. By acknowledging and learning from the past and questioning the reasons behind current organizational and societal structures, Smith believes we can better shape our institutions to create a more just and equitable world.
Smith will be chairing the upcoming History and Health: Racial Equity Symposium on September 21, and he is involved in a number of other VCU and School of Dentistry-sponsored events happening throughout September and October. We caught up with Smith to talk about these events as well as his work as an ethicist and DEI practitioner both locally and nationally.
Let’s start with the upcoming History and Health: Racial Equity Symposium. What is the focus of the event and what can participants expect to learn?
I’m very excited to be the symposium chairperson for the inaugural History and Health: Racial Equity Symposium hosted by VCU Continuing & Professional Education on Wednesday. I think it will be very beneficial for everyone involved. Not only will participants look at past and current examples of structural racism in science and health care, they will also gain an understanding of how their experiences today are shaped by history and, we hope, be motivated to pursue individual and institutional change.
I encourage everyone to check out the amazing line up of speakers. They will be presenting on a variety of topics and sharing stories about their personal work designed to spark conversation and challenge everyone to address inequality wherever they see it.
For more details, check out the recent Continuing Conversations podcast in which I spoke with Conor Lobb at VCU Continuing and Professional Education about the event. The symposium is open to all health care professionals and the cost of participation is largely subsidized by VCU.
When confronted with a racist past, how do organizations attempt to make things right?
This is an interesting and difficult question which all people and institutions must confront. I touched on it in a recent guest editorial in the American Journal of Bioethics titled History of Racism in Healthcare: From Medical Mistrust to Black African-American Dentists as Moral Exemplar and Organizational Ethics—a Bioethical Synergy Awaits.
To me, it’s a question of organizational ethics and identity. However, it’s a question that has not been centered enough in the health care realm. As health care professionals, we hold ourselves to be moral exemplars, often taking an oath to do no harm. If that is the foundation, is there an intrinsic responsibility held by health care professionals and institutions to attempt to right past racist practices and address systemic racism that exists today? And, if so, how? I think the answer is often different and nuanced depending on the organization and its history. In my American Journal of Bioethics editorial, I discuss the intentional exclusion of Black professionals in the American Medical Association (AMA) and the American Dental Association (ADA). I note that the ADA issued a formal apology in 2010 about these discriminatory practices, and also highlighted Emory University for the formal apology they issued in 2012 about anti-Semitic practices that contributed to the closing of its dental school in 1988. Closer to home and more recently, VCU and VCU Health boards voted last week to approve a resolution that acknowledges and apologizes for the treatment of Mr. Bruce Tucker, a Black man whose heart was transplanted to save a White man without his his or his family’s consent, as well as the people whose remains were discovered in the East Marshall Street Well.
But, what comes after the apology? So much of atoning for these issues depends on listening to affected communities and incorporating their feedback into policies and practices. Organizations need to take seriously and understand the feedback they receive from marginalized communities. Can they always meet specific requests, for example when a patient requests a provider of a certain ethnicity or who speaks a certain language? No, but they can be aware of the impact of representation and language and work to make those patients feel more comfortable in their practice. They can also be aware of the disparities created by decades of systemic racism and take action to untangle those threads that still impact the organization.
There is rarely a definitively right answer to many of these questions. However, that doesn’t mean that we shouldn’t stop asking them or seeking solutions to very real problems.
How do you apply your experience as an ethicist to your profession as well as at VCU School of Dentistry?
My role at the school focuses on making it a welcoming and inclusive place for students, faculty, staff and patients of all backgrounds, as well as ensuring our students have the tools they need to become ethical practitioners when they enter the profession. I oversee the ethics curriculum at the school and teach the Ethics, Professionalism and Ethical Decision-Making course in the spring semester. Since taking over this course, I have strived to teach it in a way that pays homage to historical racism, both nationally and locally, that has led to medical mistrust and disparities among communities of color. You can learn more about this course by reading this recent MCV Foundation article.
One of the most important things that I can do is to help our students realize their capacity for making change. So many students enter dentistry for altruistic reasons, and we need to foster that inspiration to affect change before it becomes diminished. Part of doing that is providing opportunities for advocacy or mentorship when needed. Our students are engaged in a myriad of efforts, and we need to not only support this work but also provide tools and knowledge to further it.
The other thing I try to do is affect organizational climate change, both at VCU and at institutions of higher learning. Climate is about the culture of the school or organization, and whether that environment is inclusive of everyone or selectively benefits a few. To do this, we need to understand where the school is in different areas and where we can make progress. One rewarding project in which I’m involved is American Dental Education Association’s (ADEA) inaugural Climate Study. The goal of this project is to foster a humanistic environment at dental schools by measuring the perceptions of students, faculty, staff and administrators regarding diversity, equity and inclusion.
I’m also very active locally and nationally through professional organizations. Recently, I taught a continuing education course at the Virginia Dental Association’s annual meeting in which I discussed how dental practices can identify and navigate ethical dilemmas when they occur. I have participated in ADEA’s leadership institute in which I worked with a team to explore the adoption of artificial intelligence in dental education, and I also have worked to measure the impacts of the COVID-19 pandemic on dental school faculty well-being. Of recent note, I was named president-elect of the American Society for Dental Ethics, which is a section of the American College of Dentistry that works closely with dental schools and national groups like ADEA to uphold high standards of integrity and honor in the dental profession. I’m looking forward to serving in this position and helping to shape national dialogue to improve dentistry for everyone.
What other opportunities are coming up for people to engage with you on these topics?
I’m proud to say that there are a number of upcoming opportunities. Connected to the History and Health: Racial Equity Symposium is an exclusive screening of Oprah Winfrey’s The Color of Care documentary on September 27 from 4-7 p.m. at the Institute for Contemporary Art at the Markel Center. VCU School of Dentistry is a co-sponsor of the event, and it is free to attend. In addition to the film screening, there will also be a panel discussion featuring myself and a number of VCU and community members, as well as a reception with refreshments and fellowship. There will also be a virtual option to attend. Those who are interested can visit the event website for more information and to register.
In celebration of Hispanic and Latinx Heritage Month, I will also be hosting a Diversity Dialogues Discussion on September 29 from 12:15-1:15 p.m. I’m excited to be joined by Ana N. Lopez-Fuentes, D.M.D., M.P.H., professor and former dean of the University of Puerto Rico School of Dental Medicine. I’m looking forward to talking with Dr. Lopez-Fuentes about her storied career, commitment to underserved patient populations and advancing historically underrepresented racial and ethnic minorities in dentistry. People can register to attend at https://bit.ly/3B5kChI.
I also want to recognize our Hispanic Student Dental Association for all that they’re doing in recognition of Hispanic and Latinx Heritage Month. They have coordinated a number of Spanish workshops over the next several months to help students, faculty and staff at the school improve communication with Spanish-speaking patients, and they’ve organized a series of lunch and learn events featuring a number of internal and external speakers. These events are geared more toward a school audience, but it is meaningful and impactful work that ultimately benefits our community.
Finally, mark your calendars for VCU School of Dentistry’s third-annual Inclusive Excellence Week happening October 17-21. Each day, we will host a virtual discussion with a featured guests on DEI-related topics in dentistry and health care. Lecturers will include Colin Haley, D.D.S., M.Ed., Paul Perrin, Ph.D., Mariah Williams, a VCU Urban and Regional Planning alum, Lisa Simon, D.D.S., M.D., and Grace D Gipson Ph.D. We look forward to sharing more information and registration details soon.