Dental Education at the Crossroads Challenges and Change (1995) / Chapter Skim
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4 The Mission of Education
4 The Mission of Education
Pages 88-143
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From page 88... ...
Although the emphasis is on predoctoral education, this chapter also examines the critical relationship between predoctoral and advanced education in general dentistry. Continuing education, sometimes viewed as part of a university's service mission, is here considered to be one more stage of a lifelong learning process that professionals must pursue and dental schools must support.
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From page 89... ...
The committee did not, however, intend to understate the role of organizations such as the American Association of Dental Schools (AADS) or limited-purpose consortia of several dental schools as promoters of change.
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From page 90... ...
on medical education and the Gies report {1926) on dental education have already been cited in Chapter 2.
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From page 91... ...
They are also intended to reflect the interconnections of the education, research, and patient care missions of the dental school and to place curriculum objectives in the context of changing concerns about faculty, students, financing, regulatory practices, and work force planning. BACKGROUND DATA The major source of quantitative data on the dental school curricuTum is a series of annual education surveys conducted and published by the American Dental Association {ADA)
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From page 92... ...
This committee did not chart statistical changes in clock hours by individual school, but the survey of deans, the site visits, and other information once again suggest considerable variation across schools. In the deans' survey, a near majority of dental school deans (25 of 54)
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From page 93... ...
Curriculum guidelines, which are not enforceable in the same way as accreditation standards, are intended to provide useful models for dental schools
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From page 94... ...
Third, many problems remain in implementing comprehensive patient care as a model for clinical education. Fourth, linkages between dentistry and medicine are weak.
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From page 95... ...
depicts graphically the traditional FIexner-Gies organizational scheme.4 It also presents two alternative models that illustrate curriculum innovations adopted after World War II by medical schools at Cornell, Colorado, and what is now Case Western Reserve {Marston and Jones., 1992~. These new models also contain other innovative concepts including comprehensive patient care.
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From page 96... ...
B Diagonal Curriculum: Structure of Basic Science and Clinical Education Basic Science i Preclinicall Clinical l Science Comprehensive ~ Patient Care I 1 2 3 4 AEGD _ _ _ _ _ Year C
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From page 97... ...
. Although these dental schools may contribute 10 to 20 percent of their budgets to medical schools for basic science faculty positions, they do not have direct control over the faculty, and this may make it difficult for them to influence course content, for example, the inclusion of clinically relevant topics and examples.
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From page 98... ...
At the risk of some oversimplification, traditional instruction and problem-based learning can be contrasted as follows. Traditional Instruction Problem-Based Learning Fact-oriented science Discipline-focused courses Abstract knowledge Larger classes Lectures Multiple-choice examinations Concept- and problem-oriented science Interdisciplinary education Clinically related problems Smaller classes Guided discussions Analytic examinations A number of dental schools have introduced problem-based learning in recent years, but little research documents its educational outcomes to date.
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From page 99... ...
Chapter 3 has already discussed this deficiency and recommended increased support for both outcomes research and practice guidelines. The background paper by Bader and Shugars explores these topics in It notes research indicating that dental faculty are as vari depth.
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From page 100... ...
CURRENT CONCEPTS AND PRACTICE The committee heard arguments that dental school curriculaand faculty are too often oriented to past oral health problems and practices. Specifically, curricula have not kept pace with changes in oral health problems je.g, the increasing proportion of patients with complex medical conditionsJ; scientific knowledge and technologies {e.g., in areas such as pharmacology and implants)
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From page 101... ...
SOURCE: American Association of Dental Schools, 1992. tices.
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From page 102... ...
In contrast, the premise of the comprehensive care model of clinical education is that students should leam to provide patient care in a manner and setting similar to those found in an efficient dental practice iVining, 1984; see, generally, 70urna] of Dental Education, Tune 1984 supplementJ.
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From page 103... ...
managing disciplinary tensions. Many of these challenges are discussed further in Chapter 6, which considers the patient care activities of the dental school from a patient's rather than a student's perspective.
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From page 104... ...
EDUCATIONAE INEFFICIENCIES Although dental schools vary considerably and detailed comparative data are generally unavailable, the committee became concerned that many if not most dental students learn in settings that are neither clinically nor educationally efficient. Students stand in line for supplies, collect patient payments, lack assistance from allied personnel, wait for faculty review of their work, and undertake clerical functions neither essential to their education nor routine in practice.
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From page 105... ...
Several of the schools visited by the committee were acutely aware of physical plant problems and had substantial renovations of their patient care space planned, under way, or recently completed. Chapter 6, which looks at these circumstances from a patient's perspective, argues that dental schools must change their approach to patient care for ethical and practical reasons.
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From page 106... ...
Other obstacles relate to shortages of faculty trained to employ new teaching methods and limited availability of instructional software and related hardware tailored to the particular requirements of dental education Which constitutes a relatively small market)
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From page 107... ...
For example, the University of Connecticut has completely integrated education in the basic sciences, and Columbia University has integrated most of the lecture portion of basic science education but still groups dental students together for smaller seminars and work groups. Several dental schools provide elective medical clerkships directed by internists.
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From page 108... ...
, with options for additional training. Fourth, dental faculty would have sufficient experience in clinical medicine so that they- and not just physicians could impart medical knowledge to dental students and serve as role models for them.
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From page 109... ...
Although more of the burden of change might fall on dental schools, medical schools would also have to make curriculum adjustments and widen their perspectives so that future generalist and specialty physicians would regard oral health as a part of their concern with total health. With or without further integration and as already argued, it is this committee's sense that basic science faculty affiliated with medical schools need to be more accountable for the education of dental students and any other nonmedical students they teach.
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From page 110... ...
Despite its recognition of the difficulties of more closely integrating dental and medical education, the majority of the committee believed that such integration is necessary to prepare dental practitioners for a future characterized by more medical management of oral health problems and more patients with complex medical problems. Within the general framework suggested above, dental and medical educators have a variety of options they can test and revise.
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From page 111... ...
ADVANCED EDUCATION Today, dental school graduates have two broad options in pursuing advanced clinical training one that focuses on general dentistry and the other, on education in one of the dental specialties.
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From page 112... ...
ADVANCED EDUCATION IN GENERAL DENTISTRY In contrast to medicine, substantial numbers of dental students do not pursue residency training after graduation. Yet, the emphasis in most dental schools on preparing students to be competent, entry-level general practitioners upon graduation puts a considerable burden on both schools and students.
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From page 113... ...
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From page 114... ...
The problem is analogous to that in medicine before graduate medical education was universally accepted. A year of postgraduate or advanced education in general dentistry would allow students to gain speed and confidence in procedures, broaden their patient management skills to cover more complex problems, and mature in the nontechnical aspects of patient care.
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From page 115... ...
Dental educators and DOD officials have a mutual interest in identifying how unfilled residencies might be made more attractive, for example, through changes in federal or other policies regarding loan forgiveness or payback arrangements. The expectation of postgraduate experience would increase the flexibility of dental schools to modify their predoctoral curricula to encompass advances in dental practice and research.
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From page 116... ...
Today, eight recognized dental specialties have 421 accredited programs in dental schools and other institutions. Table 4.2 lists the specialties and
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From page 117... ...
Likewise, educators interested in developing a serious research training component within a dental school should focus on programs leading to a doctorate not a master's degree. This argument is reinforced in Chapter 5.
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From page 118... ...
The committee found few data on the allocation of resources between predoctoral and advanced dental education. One dean reported that 30 percent of faculty effort at his school is directed to advanced education, which accounts for 10 percent of enrollmentbut 45 percent of clinic revenues Hunt, 1993 I
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From page 119... ...
Questions remain, however, about whether dental and medical schools are prepared to invest resources in lifelong learning programs for dental professionals that are based on practitioners' concerns, patients' needs, and practice realities Chambers, 1992b; Davis and Parboosingh, 1993~. OPTIONS FOR CONTINUING EDUCATION The committee found a range of continuing education offerings, representing wide differences in intensity and scope.
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From page 120... ...
In Washington State, which also has a strong AHEC program, the University of Washington dental school is extensively involved in continuing dental education. ACCREDITATION AND EVAEUATION Following the path of other health professions, the AADS section on continuing education has endorsed a set of accreditation
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From page 121... ...
The committee also recommended establishment of a PRP steering committee and a review committee on continuing dental education. In early 1993, the Continuing Education Recognition Program was established under the auspices of the ADA in cooperation with 11 other national dental organizations {ADA, CERP, 1993a)
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From page 122... ...
FACULTY The day-to-day fulfillment of the educational mission of dental schools depends on the quality and commitment of their faculty. Whether students enter practice with appropriate clinical skills and with critical thinking skills to guide them throughout their careers and whether they leave with positive attitudes about dental education depend largely on faculty.
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From page 123... ...
Among the dental schools visited by the committee, such initiatives had included the consolidation of traditional departments into larger units, the establishment of active curriculum committees, the formal study of the content and interrelationships of courses, the introduction or expansion of faculty development programs, and even the adoption of early retirement programs. Such structural and procedural changes have the potential positive effects of focusing governance arguments on the relative contribution of parts to the whole rather than on the merits of the parts in isolation.
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From page 124... ...
In 1992, after the number of schools had grown to 60 and then fallen back to 55, dental schools had more than 3,300 full-time faculty in the basic and clinical sciences, more than 6,700 parttime faculty, and slightly less than 16,000 students. About 93 percent of the part-time faculty (or 1,275 full-time equivalents (FTEs]
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From page 125... ...
About 4 percent of faculty were African-Americans; other minorities comprised about 8 percent. ISSUES Dental school faculty are clearly a diverse group with quite varied training, responsibilities, and concerns.
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From page 126... ...
The same argument holds for the new expectations with respect to research and patient care outlined in Chapters 5 and 6. The importance of faculty development is increasingly being recognized in dental schools.
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From page 127... ...
Being teachers as well as dentists, however, clinical faculty are particularly obligated to serve as role models of criticat thinking in practice. Faculty practice plans were recommended to the committee as a dual-purpose strategy to strengthen dental school faculties.
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From page 128... ...
As noted earlier, the committee heard competing views about the latter issue. One argument is that generalist faculty should take the lead in educating students in comprehensive patient care because they can best exemplify the general practice model and philosophy that is the foundation of most predoctoral programs.
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From page 129... ...
In medical schools, a major strategy for augmenting salaries for clinical faculties has been the faculty practice plan. This strategy, already mentioned in the discussion of role models, is examined further in the discussion of financing dental education in Chapter 7.
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From page 130... ...
The result may be a perception that teaching and patient care are relegated to second-cIass status ;Scheetz and Mendel, 1993~. The concern about how to assess performance in teaching for tenure-related purposes reinforces questions about measuring educational outcomes that are troublesome in many contexts including curriculum reform, licensure policies, and accreditation standards.
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From page 131... ...
STATISTICAL PROFILE In 1993, 54 dental schools enrolled nearly 16,000 predoctoral dental students and graduated more than 3,800 {AADS, 1993b)
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From page 132... ...
Student enrollment statistics show great variability in state residence, gender, race, ethnicity, and graduation from foreign dental schools (ADA, 1993a, b, c)
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From page 133... ...
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From page 134... ...
As noted in the background paper by Capilouto et al., the number of foreign dental graduates admitted with advanced standing to U.S. dental schools has grown sharply, nearly doubling from 1990 to 1992.
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From page 135... ...
Nonetheless, as discussed further in Chapter 8, the committee is troubled by shortcomings in the processes for assessing student performance and graduate competency, and it is concerned that these shortcomings may be even more serious for foreign dental graduates who enter with advanced standing. The committee urges dental educators, accrediting organizations, and related groups to assess current policies for the admission, education, graduation, and licensure of graduates of foreign dental schools and to eliminate admissions policies or other practices that may exploit these students or threaten the quality of patient care.
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From page 136... ...
The high cost of dental education contributes to concerns that students from Tow- and middle-income families will lose access and that only those from wealthy families and those poor enough to qualify for substantial income-based financial aid will be able to afford dental school. In addition to considering the implications of the tuition and debt situations for both students and schools, the committee was 20 15 a, a Dig In a)
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From page 137... ...
SOURCE: American Association of Dental Schools, 1993b. concerned about the implications for practitioners and patients.
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From page 138... ...
Stipends are the norm in hospital-based programs, primarily for oral and maxillofacial surgery and general practice residencies; they are common if not universal in pediatrics and advanced general dentistry.) Efforts to control tuition and educational costs generally are discussed in Chapter 7 and in the background paper by Douglass and Fein.
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From page 139... ...
The fourth area reflects an acknowledgment that although the insularity of most professional schools-and dental schools in particular has its comforts, isolation can be stifling. The committee was impressed by what it heard of efforts to create a sense of community among health professions students.
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From page 140... ...
FINDINGS AND RECOMMENDATIONS Because education is the most visible mission of dental schools, the committee commissioned a background paper on curriculum by Tedesco and focused many of its information collection activities on issues related to curriculum, faculty, and students. The committee examined extensive analyses of dental education.
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From page 141... ...
They offer a mix of aspirations and instrumental actions to move toward desired goals. They need to be considered in conjunction with Chapter 6's recommendations about the patient care mission of dental schools, Chapter 8's consideration of licensure and accreditation policies, and Chapter 9's discussion of work force policies.
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From page 142... ...
To prepare students and faculty for an environment that will demand increasing efficiency, accountability, and evidence of effectiveness, the committee recommends that dental students and faculty participate in efficiently managed clinics and faculty practices in which · patient-centered, comprehensive care is the norm; · patients' preferences and their social, economic, and emotional circumstances are sensitively considered; · teamwork and cost-effective use of well-trained allied dental personnel are stressed; · evaluations of practice patterns and of the outcomes of care guide actions to improve both the quality and the efficiency of such care; · general dentists serve as role models in the appropriate treatment and referral of patients needing advanced therapies; and · larger numbers of patients, including those with more diverse characteristics and clinical problems, are served. The committee recommends that postdoctoral education in a general dentistry or specialty program be available for every dental graduate, that the goal be to achieve this within five to ten years, and that the emphasis be on creating new positions in advanced general dentistry and discouraging ad
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From page 143... ...
Although the next two chapters of this report catalog yet more problems in the areas of research and patient care, their recommendations focus on steps that would address not only those problems but also some identified in this chapter. For example, greater research involvement by clinical faculty would almost certainly reinforce the links between basic science and clinic education, and revitalization of the patient care mission would likewise help make clinically current and patient-centered education a reality.
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