Reforming Dental Health Professions EducationReforming Dental Health Professions Education

Dom DePaola and Hal Slavkin Dom DePaola and Hal Slavkin

Santa Fe GroupSanta Fe Group

What we do know:What we do know:1. Disease patterns are changing

2. Knowledge is exploding

3. Demographics are changing

4. Health disparities are prevalent

5. Mouth is connected to the body

6. A new science of medicine is here!

7. Current dental practice is self-limited

8. Dentistry is left out of primary health care

9. Dental students cannot process current curriculum content

10. Costs of education and health care are increasing

11. A new health care system is here!

12. Support for education is diminishing

13. Extramural focus is limited but improving

14. Competencies for clinical practice need to be redefined

15. Faculty recruitment and development is necessary

16. Research and the scientific method are not integral to the fabric of education

17. Dental manpower is diminishing

18. Science transfer to practice is too slow

19. Dental education remains inflexible

20. Allied Health Professions need expanded opportunities

What we do know:What we do know:

There is a huge chasm and disconnect between There is a huge chasm and disconnect between

the expanding knowledge base, between what the expanding knowledge base, between what

is taught, how it is taught, and the clinical is taught, how it is taught, and the clinical

practice of dental medicine. practice of dental medicine.

+ professional isolation

+ health care costs

+ reimbursement policies and finances

+ health outcomes

+ health disparities

+ access to care and licensing regulations

+ educational preparation

+ practice characteristics

Pearson and Douglass, St. Luke’s Health Initiatives, June 2003

The gap in science transfer to patient care isThe gap in science transfer to patient care is rooted in two fragmented and separate health care systems – the consequences – the consequences of which are enormous in terms of:of which are enormous in terms of:

……Evidence into PracticeEvidence into Practice

The dental education community has

responded to the winds of change with some

growth and little change!

Tedesco, J.Dent.Educ. 1995, 59, 97

• Increased use of computers and web-based learning

• Enhancement of competency evaluation methods

• Creation of early patient care experiences, curriculum decompression

• Increased community-based care

• Increased use of evidence-based dentistry

Survey of Dental EducationSurvey of Dental Education

Kassebaum et al, J Dent Educ, 2004, 68(9), 914

Unifying Vision of Dental EducationUnifying Vision of Dental Education

Dental education is a continuum that leads from predoctoral science and clinical education, moves into professional training in the clinical, biomedical, and

behavioral sciences, and then extends on into life-long learning in dentistry. The notion of an educational

continuum is fundamental and profound.

Dental Science EducationDental Science Education

Preferred ModelPreferred Model Reductive Science

PhD

DDS, PhD

DDS/CE

Basic Research

Translational Research

Clinical Investigation

Integrative Sciences: biomedical; population; behavioral

Adapted from M.Cox, Harvard Medical School, 2003

The unifying vision will also result in:The unifying vision will also result in:

• Practitioners trained to meet the oral health needs of the population by providing them foundational knowledge, critical thinking, problem-solving, teaching skills and attitudes for success.

• A new generation of scientists trained to advance the oral health of the population.

• A new generation of adaptable dental educators who can respond to an ever-changing reality.

• Students and practitioners who are scientifically literate and embrace life-long learning.

• Enhanced clinical competence and performance in clinical decision making.

Dental Education Reform:Dental Education Reform:

1. End the “silo” approach to education

2. Create an efficient pathway to link competencies to subject matter and learning experiences, which, in turn, are linked to evaluations that measure performance of these competencies

Hendricson & Cohen, Acad Med 2001, 76, 1181

Clinical Paradigm ChangeClinical Paradigm Change

Patient Assessment by Primary Health Care Team (physicians, dentists, other health care professionals)

Risk Assessment

Diagnosis

Referral to specific clinical entities

Patient returns to team

Discharge order(s)

Recall

Education Implications of Education Implications of Contemporary Oral Health:Contemporary Oral Health:

** Some of the most pressing issues are no longer purely dental in nature

** Provision of oral health care is increasingly intertwined with public health policy, resource allocation, and care delivery/access issues

** “Splendid isolation” of dental practitioner is in question

** The perception of oral health as an integrated component of overall wellness emphasizes the role of dentists as oral physician.

Hendricson & Cohen, Acad Med 2001, 76, 1181

It is time for a “creative revolution” to It is time for a “creative revolution” to

sweep across the profession to bring it sweep across the profession to bring it

into the 21into the 21stst century led by a century led by a

contemporary, vibrant and exciting contemporary, vibrant and exciting

educational enterprise!educational enterprise!

• Pew Center’s National Dental Education Program

• Institute of Medicine Report, 1995

• Dental Education at the Crossroads

• American Dental Association’s Future of Dentistry

• 2000 Surgeon General’s Report Oral Health in America

• Surgeon General’s 2003 National Call to Action

Recent Reports on Dental Education ReformRecent Reports on Dental Education Reform

 

+ Community-based education

+ Replacement of licensure exams with a mandatory post-graduate year of study

+ Competency-based education and accreditation

+ Expanding teaching of evidence-based dental medicine

+ Renewed emphasis on prevention strategies including:

** risk assessment

** behavioral interventions

** medical management

+ Establishment of Interdisciplinary teams - clinical collaborations

+ Virtual dental education

Trends in Dental EducationTrends in Dental Education

Pearson and Douglass 2003

Unfortunately:Unfortunately:

** The great majority of schools continue to use “lock- step: approach to basic and clinic science instruction, with little integration of science underpinnings at the clinical level and with continuing metastatic, irregular additions to the curriculum.

** It continues to be easier to base a curriculum on what was necessary to teach rather than what will be

necessary to learn in the future!

DePaola, 1990

……Evidence into PracticeEvidence into Practice

AssumptionsAssumptions1. Reform of oral health education is critical to enhancing the quality

of health and well-being for all people in the United States.

2. Health professions education environments are not interdisciplinary, whereas health care clinical practice and clinical research require explicit interdisciplinary efforts.

3. No one model of template for dental education will suffice for all dental schools.

4. There must be a unifying vision of what dental education “could be” and what a 21st century practitioner “could be”.

5. Adequate resources must be aligned to realize the vision of dental education.

6. A common language and core competencies across health professions have not as yet been achieved.

7. Competencies must be well-defined and renewed thru a lifetime of professional activities.

8. Evidence-based core competencies should be established across all health professions and integrated with clinical care services.

9. Dental education must enable individuals to learn, to re-invent and to attain contemporary competencies over a lifetime.

10. The collaborative role of allied health professionals must be expanded significantly, holding open the possibility of developing pediatric oral health therapists, among other new “reconfigurations” of providers.

11. Integrative biomedical, population, behavioral, social and economic sciences must be incorporated into the curriculum at every level.

12. There must be regular assessment of curricula and pedagogical outcomes and continual documentation of clinical skills

13. Scientific discovery coupled with translating science and technology into clinical practice must be a core value of dental education.

AssumptionsAssumptions

14. Critical thinking, problem-solving, information management, leadership and teamwork, and life-long learning must be integral in all dental education models.

15. Humanism, professionalism and communication skills must underpin the education process.

16. Innovation, creativity and the nurturing of ideas must permeate dental education and clinical practice.

17. It will take a village to reform dental education, including individual faculty members, organized dentistry, industry leaders, funding agencies, insurers, patient advocates, the media, public health advocates and practitioners, leaders from research, education and government, and the public.

18. This conference cannot be the end, it MUST be the beginning. We must take concrete steps and “walk our talk;” we must begin and sustain the journey.

AssumptionsAssumptions

The lack of an umbilicus to the dental school The lack of an umbilicus to the dental school and/or hospital is a major contributor to the and/or hospital is a major contributor to the dentists’ professional isolation and the slow dentists’ professional isolation and the slow

transfer of contemporary science to patient care!transfer of contemporary science to patient care!

Reform AgendaReform Agenda

Competency-based assessment

Decompress the curriculum through elimination

Increase collaborations between dentistry and other health professions

Feature curricular emphasis on dental/medical interactions

Redirect basic sciences toward pathophysiology using PBL or other appropriate education techniques

Expose students to patients from first through last days of the curriculum

Revitalize the science underlying clinical decision-making via evidence-based approaches

Organize group practice teams to promote continuity and expand peer teaching

Increase community-based clinics as training sites

Include a clinical experience that replicates the comprehensive care environment for the general practitioner

Utilize web-based and computer-based technology for enriched learning

Redirect dental school clinics to serve oral health needs of the public

Hendricson & Cohen, Acad Med 2001, 76, 1181

Dental Education Reform:Dental Education Reform:

Dental schools should aspire to become “learning organizations” where:

There is a high capacity for implementing change

There is comfort in the processes to support innovation

Hendricson & Cohen, Acad Med 2001, 76, 1181

Why is reform needed now?Why is reform needed now?

* A critical need to address the problems in the current system of dental education, including:

   inability to train practitioners to care for all patients, including the disadvantaged

   inability to nurture the critical mass of critical thinkers and problem-solvers for research and academia

   inability to train socially responsible practitioners

   lack of diversity in students, educators and practitioners

   lack of expertise in specific content areas; for example, pediatric oral health care; care for special populations; general health; cultural competency; experience with the underserved; social context with responsibility; behavior and communication skills

   the continuing focus on oral health and technical skills to the neglect of overall health and the social/behavioral focus needed to address disparities

   lack of interdisciplinary perspective/practice

lack of ability to relate to and address the overall health of the patient.

Why is reform needed now?Why is reform needed now?

** A need to reduce costs of education.

** A need to integrate biology into the fabric of dental education and clinical practice.

** A need to resonate with the mission of the university and/or academic health center.

** A need to expand access to education and clinical care.

** A need for leadership and citizenship development.

** A need to integrate effective and efficient management, staffing, and clinical productivity.