State of Dental Education Today - Opinions?

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I'm a huge fan of Dr. Charles Bertolami. I eat up all of his literature and I definitely look up to him.

What do you see as the biggest challenge to dentistry today and how should the profession be adapting and working to meet this challenge?

In addition to my concerns about dental scholarship and the reputation of the profession, I see vulnerabilities related to financing dental education. Right now, it's not at all clear that dentists whose education was subsidized by the state through in-state tuition rates are more likely to charge patients less, to accept patients on public assistance, or to settle in dentally underserved areas. Given continuing budget cuts, it's surprising that the states that fund dental education have not yet attempted to exploit their leverage with students, who are now free to leave the state that helped fund their training after it has been received. I see this as a vulnerability and also as a great opportunity, because cash-strapped public schools should be able to provide students with the option to either pay full freight or "give back" by committing themselves to a period of public service to the funding source. It seems to be just a matter of time before states seeking to cut budgets arrive at such a solution.

How would you describe the key changes that have taken place in dental education—including faculty shortages—and their impact on the profession?

I had the opportunity to look into this in some detail as the primary author of the oral health chapter of the 2011 report of the National Research Council on research training in the biomedical, behavioral, and clinical research sciences. The key evidence for a shortage of dental faculty is found in the annual number of vacant budgeted faculty positions—amounting to just over 300 such positions in 2007–2008. By way of comparison, the analogous figure was just under 300 in 1969. While much has been made of the number of vacant budgeted faculty positions as a metric for a faculty shortage, a difference of just about 20 when comparing 1969 to 2008 does not seem that impressive over a nearly 40-year time span. What is impressive, though, is that in 1969, of the nearly 300 full-time vacant budgeted positions, more than 100 were in the basic sciences. Between 1998 and 2008, the number of biomedical science faculty declined nearly 30%. Interestingly, there were almost 2,000 faculty members in basic science departments in dental schools in 1982. If used as a basis of comparison, it would account for a dramatic 65% drop in biomedical science or basic science faculty in a little more than 25 years. It does appear that dental education is moving away from the biomedical sciences in its educational programs.

I think this trend is going to continue: Using the Carnegie Classification of Institutions of Higher Education, dental schools are no longer being established within the highest Carnegie classification of "doctorate-granting universities with very high research activity" (RU/VH) or "high research activity" (RU/H). Today, new dental schools are mainly associated with parent universities identified as "special focus institutions." This is not necessarily a bad thing, but I do think that the existence of dental schools at the most prestigious universities in the country has made a difference in the perception and the advance of the dental profession as a whole. I do worry that the richness and diversity of health sciences education within a major research university is at risk of being lost.

How then can the profession develop such intellectual contributors among the ranks of dental students?

This is an interesting dilemma that is especially pronounced because of the nature of dental students and the short duration of their university-based education. While few openings for tenured-track professors in most disciplines go begging, in dentistry, it is a struggle to find someone both interested and qualified for these slots. This is partly because dental students generally start out wanting to be dentists, not professors, and those who might like to lure them into academia must convince them within just 4 years to change their career goal from being a dentist to being a professor. At least in medicine, there are many more years of exposure to institutional practice and role models who embody what a university is all about.

My suggestions for attracting and retaining excellent students and practicing dentists to academia include a combination of incentives and role models. I believe universities with a prohibition against full-time faculty having outside practices restrict their ability to attract excellent people. Schools that allow a full-time dental professor to maintain a private practice may have a recruiting advantage in this regard. These professors would serve as role models for students.

The place of research and research experiences for pre-doctoral students is frequently a contentious topic, especially among academicians. What are the main issues here and where do you stand?

I think the real issue isn't research; it's scholarship. Research is just one manifestation; it is one way by which a student can learn the rigor of what it means to have an hypothesis that can be tested and either rejected or accepted, and to be able to draw rational conclusions. These are not things that age or experience necessarily enhance unless an individual is open to a scientific approach and is comfortable looking at data and employing statistical methodologies. Students who engage in research get a strong background in the professional assessment of the literature and can develop, with guidance, a solid background in evidence-based practice. The argument against requiring a dental school research experience is also compelling. It focuses on the esthetic—the dentist's deep appreciation for and satisfaction with achieving beautifully executed dentistry. So, given the limited amount of curricular time, there are those who question the extent to which we should be sacrificing this imprinting of the student with the elegance of truly outstanding dentistry for the sake of these more abstract principles of science.

I actually think they are both important and blending them is the key. There's no need for there to be a conflict between the technical demands of genuinely outstanding dentistry and science.

One of your main scholarly interests is professional ethics. How did this interest develop, and how can ethics be imparted to students?

My focus on this issue does not come from the position of a professional ethicist but from that of a pragmatist concerned about the problem of ethical misconduct among students. As a dean, I've had to deal with inconsolable parents and immensely distraught students as a result of ethics-related disciplinary actions, including dismissals.

The fact of the matter is that ethics is not an abstraction. It is one of the essential elements we try to instill. Students need to understand the value of the good they can do as dentists and realize it's not worth risking that by taking foolhardy chances.

We've found that one way of dealing with student misconduct has been to treat students like the adults they are and not to pit students against faculty. One way we try to do this is by a peer-review committee composed of two students from each class, with the chair of the student council as chief judge and a faculty advisor. Some cases are dismissed or result in relatively minor disciplinary actions, but some students have been dismissed from school. This has been an important experience for members of the peer-review committee—many of whom have had sleepless nights when deliberating a case.

A program that has encouraged ethical behavior in a positive way is the clinical outreach program run by Stuart Hirsch, DDS, vice dean for International Initiatives and Development. These 200 students return from this experience abroad transformed. I think it's because they experience the travel, the risks, the inconvenience, and the exhaustion, but know that they are doing so willingly, purely from intrinsic motivation, not the prospect of an external reward like credit, grades, or money. For students, this goes directly to the human dimension of doing something good with their lives and it has a big impact on them.

Teaching an understanding of the sciences and competency in the clinical skills are essential elements of developing students into dentists. How does NYU help students develop all the other essential attributes of being a dentist?

At NYU, the faculty has defined three overlapping attributes—like a Venn diagram—that dental students should strive to possess and that permeates our entire curriculum. They include: technical excellence; an identity as men and women of science; and an indefinable something more, akin to emotional intelligence, that people expect from a doctor.

To elaborate, students should aspire to achieve technical excellence, with mere competence as a fallback position. The idea of cultivating an identity in students as men and women of science may sound like a platitude, but we use a meaning borrowed from Tony Iacopino, DMD, dean at The University of Manitoba: "a sophisticated consumer of research," someone who knows that a scientific literature exists; knows where to find it; can read it and find it intelligible, can critique it; has the capacity to distinguish what is true from what is not true; and who can identify treatments that are safe and effective. This is more important than ever in this era of junk science. The third element is based on the work of Daniel Goleman, whose book Emotional Intelligence highlighted the importance of interpersonal skills. It includes qualities people expect in their doctors, such as being ethical, sympathetic, and caring in their relationships, as well as being comfortable with themselves and others in their environment.

http://www.dentalaegis.com/id/2013/06/a-conversation-with-charles-n-bertolami-dds-dmedsc

Do you guys agree, have any opposing thoughts, or have anything else to add?

 

[periopocket]

Lower tuition and smaller class sizes please!

 

[doc toothache]

Originally Posted by Dr. Charles Bertolami
In addition to my concerns about dental scholarship and the reputation of the profession, I see vulnerabilities related to financing dental education. Right now, it's not at all clear that dentists whose education was subsidized by the state through in-state tuition rates are more likely to charge patients less, to accept patients on public assistance, or to settle in dentally underserved areas. Given continuing budget cuts, it's surprising that the states that fund dental education have not yet attempted to exploit their leverage with students, who are now free to leave the state that helped fund their training after it has been received. I see this as a vulnerability and also as a great opportunity, because cash-strapped public schools should be able to provide students with the option to either pay full freight or "give back" by committing themselves to a period of public service to the funding source. It seems to be just a matter of time before states seeking to cut budgets arrive at such a solution.

The suggestion is to introduce a concept used long ago in some countries, who demanded the government be reimbursed before a graduate/practitioner was allowed to leave the country.

 

[ushaseos]

On that first point aren't there programs where you can sign up for which offer loan forgiveness of up to 50K a year when working in high need areas? Not quite a state solution but state schools could do something similar. If cali state schools do that though, they'll have riots because UCSF and UCLA ain't cheap. I am sure there are other state schools which are not all that much cheaper than some private schools.