Small, human moments—ones in which a physician puts a smile on a patient’s face, for example—can mean all the difference in the practice of medicine. One resident-led project at the University of Texas (UT) San Antonio Health Science Center is aiming to focus on ways to make that smile healthier, and to connect with patients in the process.
Through the project, physicians will provide patients with kits that include toothbrushes, fluoride toothpaste, floss and mouthwash and have a quick discussion about the importance to overall health of oral hygiene. This year, the Accreditation Council for Graduate Medical Education (ACGME) awarded one of 23 Back to Bedside grants to the project, which is called “Sonrisa: Improving Patient Connection Through Oral Health Kits in an Underserved Population.”
“I was excited to be part of this project because they [the ACGME] have offered this opportunity and funding to inspire us to come back to what really matters—forming that humanitarian connection between us and our patients,” said Eve Vanderneck, MD, a PGY-3 in the family and community medicine residency program at UT Health San Antonio who is helming the project. “I believe this project will improve our joy in medicine and remind us, as residents, that we really do matter and that the care that we provide does make a difference.”
UT San Antonio Health Science Center, the academic health center of UT Health San Antonio, is part of the AMA GME Competency Education Program, which helps institutions meet the ACGME Common Program Requirements through a flexible on-demand micro learning approach for residents. The program fits into demanding clinical schedules and is supported by streamlined reporting tools for program administrators. Learn more.
Boosting a community in need
With the “Sonrisa” project, physicians at UT Health San Antonio hope to help economically and socially marginalized patients, who have health challenges at even higher rates than do those in surrounding communities. Data from the U.S. Census Bureau reveals that 17.1% of the residents in San Antonio are living below the federal poverty line, 16.9% are living with at least one type of disability and 18% do not have health insurance—all statistics higher than the statewide averages.
Dr. Vanderneck said the project will serve patients at the Family Health Center Clinic in downtown San Antonio, which has one of the most economically disadvantaged populations in the city. More than one-fifth of the patients served by the health system do not have health insurance, she said, and many have trouble accessing necessities such as food, housing and hygiene items including oral health products.
“It can be disheartening to send someone out the door saying: Hey, I really recommend X, Y and Z medication that a patient may or may not be able to afford; or I really recommend you get into physical therapy, but I don't know whether or not I'll see that patient again or if they'll be able to get transportation to physical therapy,” she said.
This initiative is different, allowing residents to forge an immediate connection between solid health advice and the means to carry it out.
All patients who are identified as needing help with oral health will be offered a kit, but the project will dovetail particularly effectively with existing well-child clinics, Dr. Vanderneck said.
“We usually give handouts and information on low-cost dental offices when our kids let us know they don't have a dentist or can't afford one,” she said. “Now we will be able to give them a brief educational intervention and send them home with tools necessary to take care of their teeth until they can schedule an appointment with a dentist.”
Putting smiles on patients’ faces
Alexis Ramos, MD, is a family physician and assistant clinical professor in the Family and Community Medicine Department of UT Health San Antonio. Dr. Ramos is the faculty mentor on the project, which is in the process of securing institutional review board approval, and Dr. Vanderneck is the resident lead.
“This project is really about leaning into patient-centered care,” Dr. Vanderneck said, adding that 65% of the population in the area identifies as Latino or Hispanic, and many also face transportation issues or language barriers. The Sonrisa project, named for the Spanish word for “smile,” brings “both tangible support—like toothbrushes, toothpaste, floss, mouthwash—as well as discussing and educating on oral health practices.”
Dr. Ramos said that periodontal disease is associated with higher systemic inflammation and worse outcomes in conditions such as diabetes and cardiovascular disease, all conditions that are common in the patients they treat.
“Our population may not have access to dentists, so an intervention we do currently is we give them a list of different low-cost dentists in the area,” she said, adding that it can be disheartening to be able to do no more. “You [as the physician] screen for these things, or they verbalize that they are having issues taking care of their oral health, and what we can do is offer them a piece of paper. We're trying to expand that to where we can give them tangible tools.”
Interactions like those in the Sonrisa project also help build a stronger relationship with the patient, Dr. Ramos said, where they might be more willing to follow recommendations on other health matters.
“There’s mistrust in the healthcare system from all sorts of different communities and our population as well,” she noted. “But when we meet them where they are and take the time to say: Hey, we see you as a whole person, including dental healthcare, I think that builds trust and rapport.”
Establishing a link between joy and residency
This is the fifth, two-year grant cycle of the ACGME Back to Bedside initiative since it was launched in 2017. More than 250 applications were received for this year’s grants of up to $10,000, which can go toward new ideas or for projects already in development.
Projects were evaluated on whether they would strengthen the patient-physician relationship, as well as whether they were sustainable, cost-effective, had defined outcome measures, innovated and were adaptable to other training programs and contexts.
“Back to Bedside demonstrates the powerful impact residents and fellows can have when they are given the opportunity to lead meaningful change,” said Nikhil Goyal, MD, the ACGME senior vice president of accreditation and the adviser to the Back to Bedside Work and Advisory Group. “The program’s focus on strengthening the physician-patient relationship is more important than ever, helping ensure that innovation in healthcare remains grounded in compassion and human connection. The remarkable quality of this cycle’s applications reflects the talent, dedication and compassion of residents and fellows across the country.”
The current Back to Bedside cycle will culminate in a presentation at the 2028 ACGME Annual Educational Conference in San Antonio, where the Sonrisa project is being planned.
Dr. Vanderneck said she is “very excited to be a part of this project.
“The Back to Bedside Initiative from the ACGME is all about going back to what matters and what brings us joy as physicians,” she added. “The demands on a resident's schedule, whether that be high numbers of patients to see or different metrics that need to be met, it can kind of distract from our ultimate goal, which for many of us is to take care of other human beings.”
