We will be posting this here since it may be of interest to all dental students. In addition, we will be posting on the residency pages.
I recently received a private e-mail from a student asking why should a student take a residency is it is not required. I answered it immediately without checking for repetitive statements. I have reviewed that answer and modified it. Since I tried to follow an outline some statements will repeat.
I reviewed this with Dr. Peter M. Gershenson, Director, General Practice Residency Program, Jacobi Medical Center. We are both program directors.
-------------------------------------------------------------------
A residency is not for everyone. Each program/residency is different. They can range from all dentistry in some AEGD programs to all hospital based in some GPR programs yet all met accreditation. Most programs are some where in between. But each dental school is different. They concentrate in different areas. So a student from one school may have different experiences from those in another dental. There are many elective areas that some schools do not offer.
Let me first start with what are the simplest things a graduate program can do.
Some states require it, but as you said this may not apply to many at this time (more states are requiring it, Delaware was the first in 1940.)
Its a year to develop efficiency, accuracy, maturity, more experience (in even routine dentistry) and confidence so you can be more productive when you start practice.
Most programs teach in a semi private practice setting, unlike dental schools.
You can gain experiences, not taught in dental school (advance oral surgerical procedures, implants, advanced dental procedure, special needs patients, emergencies [urgent dental care, dental trauma, and also care of medical emergencies on your dental patients].
Develop communications skills with patients and other professionals.
It allows for networking to help set your career goals (exposes you to speciality areas that you may decide you like).
And most important:
It is a year to DECIDE WANT YOU WANT TO DO.
Learn more while being paid after this you pay for CE programs.
Get 250 credits to AGD (if you are interested).
Patient contact, especially with those not accepted to dental school, but may be seen in your practice.
Making mistakes on some one else reduce the risk of malpractice.
Higher pay when you start practice many residents are offered better deals than those straight out of dental school.
AND: TAKE THE PRESSURE OFF ANY BOARD EXAM if you dont pass, you still have a job the residency. You still have months to take/retake board exams or go to a state that requires only a residency.
Why has Delaware required a residency year (or military experience, or several years in private practice since) since 1940.
Required Dental Residency - The Delaware Experience
Why did Delaware decide on requiring a residency:
Improved Competency
Improved Confidence
Additional knowledge in fields not covered in dental schools
Modeled after medicine
In an article, A Report on a Requirement of a Dental Internship for Dental Licensure: The State of Delaware by State Board of Dental Examiners, in the
Journal of Hospital Dentistry, 1971 (note: then a residency was called an internship) a total review was given. I was allowed to review the facts with the board a long time ago.
The history from 1935 shows there was limited accreditation of schools and programs. The schools did not follow a standard guideline. Delaware had reciprocity with nearby states and even with some states through out US. Delaware was one of first Boards to recognize and participate in National Boards. But there were problems. The standard of practice poor and there were many complaints and problems. There were poor controls on the schools and examines. The tests were curved (now, the National Boards have already changed their report of grades and plan to go to pass/fail).
From 1935 to 1939, Delaware changes its code. They ended reciprocity and stopped accepting the National Boards. They modeled the dental code after Medicine hospital experience. They wanted to gain more respect and to help gain parity with medicine. They gained the respect in health care and from the public. With medicine the helped with the Academy Of Medicine Both Dentists and Physicians are equal. At the hospital there is one staff, the Medical/Dental Staff with equal status.
They created a new Code of Ethics which was answerable to Board of Dental Examiners, not state society. They prohibit advertising then (this has changed locally and nationally). They require additional experience before practice, like medicine. They decided that an internship (now called a residency) like medicine was ideal. They were realistic and had other options: military service or 5 years private practice.
The law passed in 1939, effective in 1940 for those seeking licensure in 1944 would need the additional experience. They allowed grandfather clause from 1940 to 1944 with no penalty till 1944. They required graduates of ADA certified schools and ADA certified internships (residency programs).
What was the experience with Law of 1939? It did not decrease numbers applying for state licensure. It increased numbers staying in state. There was more service to under serviced via hospital programs and those with the additional experience. It increased competency as seen on exams. It gave time for graduates to think of future plans so they knew what they wanted to do. It improved communications and mutual respect with both fellow dentists and with other health care providers. It improved comprehensive health care and increased patient care especially for the special needs patients, but also in hospitals and emergency (24 hrs.) coverage.
What were the problems expected? Would it slow dentists coming to the state there was no evidence only comments, complaints. Would the limited income of a program penalize economically disadvantaged there were other options besides an advanced program, the programs had salaries that are competitive .. and when they started practice, they got higher paid, and were better prepared.
Realizing the debt problem, Delaware in 2002 started a loan pay back program. Realizing back in 1939 that all programs were not the same, they have continued to require that programs must be accredited. While this may limit people low in their class, there are still other options.
The Delaware Board was easy for those qualified and prepared. (I agree all boards create pressure and panic). The early exam required three parts written / clinical / DOR. The written was based a many items that advance training would allow you to pass. The written also had a clinical treatment planning exam, asking for different treatment options again advanced training helped. With the advanced training any where in the country it was easy to pass without, well it was hard.
The boards have changed. Now they accept the National Boards so there are still three parts clinical / DOR / National Boards. Residents recent grads of any program in the country have near a 100% pass rate. Graduates right out of school had more problems especially with the clinical.
After these requirements, and especially any residency, the dentists are better qualified (as any one would be with experience). The dentists have more of a desire to pay back for their education by teaching/volunteering. There is improved access to care, especially the compromised patients. It is easier to work with MDs.
What are the problems a residency program may have? The top student may not be best for a program, but it is hard to refuse them. There may be candidates who do not desire a residency, but need one to practice (like in NY now). Some may feel its owed to them, because it is required. It puts some pressure on the students lower in class since it may be hard to get into a program and some states only accept a residency. Many residency programs want to help the students who may need more time to catch on, but cant have a complete program of weaker students (the match will effect that).
What is the future? Mandatory vs. Encouraged? Studies/reports by ADEA (American Dental Education Association before called AADS), the IOM (Institute of Medicine), and ADA on the future of dentistry recommend a required year. NY has the residency in lieu of an exam. Other states have followed. Delaware requires both.
The studies suggest it can increased the scope of practice and give the time needed for all the new areas. It will give more confidence and experience which will all increased care for the medically compromised. It may help reduce the crowded undergraduate curriculum (other steps are being taken in the schools).
There are problems there not enough programs for everyone. There are not enough educators to teach in the programs. Which will be better an AEGD or GPR.
Are the salaries enough? Is there a good dental experience? Will there be learning of dental emergencies (especially after hours) and medical emergencies in dental patients? Can programs get attending emergency coverage? Will there be support of non dental rotations? How will it effect salaries in private practice? Will it improve professionalism and attitudes?
Peter M. Gershenson, DDS
Director, General Practice Residency Program
Jacobi Medical Center
Bronx, NY
Robert N. Arm, DMD
Vice Chair, Dept. of Oral&Maxillofacial Surgery and Hospital Dentistry
Program Director, General Practice Dentistry Residency Program
Christiana Care Health Services
Wilmington Hospital
Wilmington, DE 19801
(302) 428-6468
(302) 428-4814(fax)
[email protected]
[email protected]
Cell 302-530-6788
I recently received a private e-mail from a student asking why should a student take a residency is it is not required. I answered it immediately without checking for repetitive statements. I have reviewed that answer and modified it. Since I tried to follow an outline some statements will repeat.
I reviewed this with Dr. Peter M. Gershenson, Director, General Practice Residency Program, Jacobi Medical Center. We are both program directors.
-------------------------------------------------------------------
A residency is not for everyone. Each program/residency is different. They can range from all dentistry in some AEGD programs to all hospital based in some GPR programs yet all met accreditation. Most programs are some where in between. But each dental school is different. They concentrate in different areas. So a student from one school may have different experiences from those in another dental. There are many elective areas that some schools do not offer.
Let me first start with what are the simplest things a graduate program can do.
Some states require it, but as you said this may not apply to many at this time (more states are requiring it, Delaware was the first in 1940.)
Its a year to develop efficiency, accuracy, maturity, more experience (in even routine dentistry) and confidence so you can be more productive when you start practice.
Most programs teach in a semi private practice setting, unlike dental schools.
You can gain experiences, not taught in dental school (advance oral surgerical procedures, implants, advanced dental procedure, special needs patients, emergencies [urgent dental care, dental trauma, and also care of medical emergencies on your dental patients].
Develop communications skills with patients and other professionals.
It allows for networking to help set your career goals (exposes you to speciality areas that you may decide you like).
And most important:
It is a year to DECIDE WANT YOU WANT TO DO.
Learn more while being paid after this you pay for CE programs.
Get 250 credits to AGD (if you are interested).
Patient contact, especially with those not accepted to dental school, but may be seen in your practice.
Making mistakes on some one else reduce the risk of malpractice.
Higher pay when you start practice many residents are offered better deals than those straight out of dental school.
AND: TAKE THE PRESSURE OFF ANY BOARD EXAM if you dont pass, you still have a job the residency. You still have months to take/retake board exams or go to a state that requires only a residency.
Why has Delaware required a residency year (or military experience, or several years in private practice since) since 1940.
Required Dental Residency - The Delaware Experience
Why did Delaware decide on requiring a residency:
Improved Competency
Improved Confidence
Additional knowledge in fields not covered in dental schools
Modeled after medicine
In an article, A Report on a Requirement of a Dental Internship for Dental Licensure: The State of Delaware by State Board of Dental Examiners, in the
Journal of Hospital Dentistry, 1971 (note: then a residency was called an internship) a total review was given. I was allowed to review the facts with the board a long time ago.
The history from 1935 shows there was limited accreditation of schools and programs. The schools did not follow a standard guideline. Delaware had reciprocity with nearby states and even with some states through out US. Delaware was one of first Boards to recognize and participate in National Boards. But there were problems. The standard of practice poor and there were many complaints and problems. There were poor controls on the schools and examines. The tests were curved (now, the National Boards have already changed their report of grades and plan to go to pass/fail).
From 1935 to 1939, Delaware changes its code. They ended reciprocity and stopped accepting the National Boards. They modeled the dental code after Medicine hospital experience. They wanted to gain more respect and to help gain parity with medicine. They gained the respect in health care and from the public. With medicine the helped with the Academy Of Medicine Both Dentists and Physicians are equal. At the hospital there is one staff, the Medical/Dental Staff with equal status.
They created a new Code of Ethics which was answerable to Board of Dental Examiners, not state society. They prohibit advertising then (this has changed locally and nationally). They require additional experience before practice, like medicine. They decided that an internship (now called a residency) like medicine was ideal. They were realistic and had other options: military service or 5 years private practice.
The law passed in 1939, effective in 1940 for those seeking licensure in 1944 would need the additional experience. They allowed grandfather clause from 1940 to 1944 with no penalty till 1944. They required graduates of ADA certified schools and ADA certified internships (residency programs).
What was the experience with Law of 1939? It did not decrease numbers applying for state licensure. It increased numbers staying in state. There was more service to under serviced via hospital programs and those with the additional experience. It increased competency as seen on exams. It gave time for graduates to think of future plans so they knew what they wanted to do. It improved communications and mutual respect with both fellow dentists and with other health care providers. It improved comprehensive health care and increased patient care especially for the special needs patients, but also in hospitals and emergency (24 hrs.) coverage.
What were the problems expected? Would it slow dentists coming to the state there was no evidence only comments, complaints. Would the limited income of a program penalize economically disadvantaged there were other options besides an advanced program, the programs had salaries that are competitive .. and when they started practice, they got higher paid, and were better prepared.
Realizing the debt problem, Delaware in 2002 started a loan pay back program. Realizing back in 1939 that all programs were not the same, they have continued to require that programs must be accredited. While this may limit people low in their class, there are still other options.
The Delaware Board was easy for those qualified and prepared. (I agree all boards create pressure and panic). The early exam required three parts written / clinical / DOR. The written was based a many items that advance training would allow you to pass. The written also had a clinical treatment planning exam, asking for different treatment options again advanced training helped. With the advanced training any where in the country it was easy to pass without, well it was hard.
The boards have changed. Now they accept the National Boards so there are still three parts clinical / DOR / National Boards. Residents recent grads of any program in the country have near a 100% pass rate. Graduates right out of school had more problems especially with the clinical.
After these requirements, and especially any residency, the dentists are better qualified (as any one would be with experience). The dentists have more of a desire to pay back for their education by teaching/volunteering. There is improved access to care, especially the compromised patients. It is easier to work with MDs.
What are the problems a residency program may have? The top student may not be best for a program, but it is hard to refuse them. There may be candidates who do not desire a residency, but need one to practice (like in NY now). Some may feel its owed to them, because it is required. It puts some pressure on the students lower in class since it may be hard to get into a program and some states only accept a residency. Many residency programs want to help the students who may need more time to catch on, but cant have a complete program of weaker students (the match will effect that).
What is the future? Mandatory vs. Encouraged? Studies/reports by ADEA (American Dental Education Association before called AADS), the IOM (Institute of Medicine), and ADA on the future of dentistry recommend a required year. NY has the residency in lieu of an exam. Other states have followed. Delaware requires both.
The studies suggest it can increased the scope of practice and give the time needed for all the new areas. It will give more confidence and experience which will all increased care for the medically compromised. It may help reduce the crowded undergraduate curriculum (other steps are being taken in the schools).
There are problems there not enough programs for everyone. There are not enough educators to teach in the programs. Which will be better an AEGD or GPR.
Are the salaries enough? Is there a good dental experience? Will there be learning of dental emergencies (especially after hours) and medical emergencies in dental patients? Can programs get attending emergency coverage? Will there be support of non dental rotations? How will it effect salaries in private practice? Will it improve professionalism and attitudes?
Peter M. Gershenson, DDS
Director, General Practice Residency Program
Jacobi Medical Center
Bronx, NY
Robert N. Arm, DMD
Vice Chair, Dept. of Oral&Maxillofacial Surgery and Hospital Dentistry
Program Director, General Practice Dentistry Residency Program
Christiana Care Health Services
Wilmington Hospital
Wilmington, DE 19801
(302) 428-6468
(302) 428-4814(fax)
[email protected]
[email protected]
Cell 302-530-6788
