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Monthly Archives: July 2012

Dr. Richard Valachovic

In this month’s letter, ADEA Executive Director Dr. Rick Valachovic traces the history of the ADEA Commission on Change and Innovation in Dental Education (ADEA CCI) and showcases its impact throughout dental education.

Last month, I spent several days in Chicago, where the ADEA CCI Liaisons and the ADEA Allied Dental Program Directors gathered for their annual summer meetings. At the ADEA CCI Oversight Committee meeting that bridged the two events, I learned from Tami Grzesikowski, ADEA’s Senior Director for Allied Dental Education, that roughly 20% of the program directors in attendance were unaware of ADEA CCI’s work.

Perhaps this lack of awareness shouldn’t have come as a surprise. Only 33 of the 641 accredited allied dental programs that are ADEA members are affiliated with dental schools, and ADEA CCI has concentrated its efforts on these institutions to date. It is not the first time I have heard that some of our members are only vaguely familiar with ADEA CCI’s accomplishments, even on our university campuses, and that many think of such achievements as being limited to curricular change.

Let me take this opportunity to remind you of how far we have come with ADEA CCI. To start with, ADEA CCI does not stand for curricular change and innovation, although a desire for curricular change was integral to its origins. ADEA CCI stands for the ADEA Commission on Change and Innovation in Dental Education. The ADEA Board of Directors formed ADEA CCI in 2005 to lead and coordinate our efforts to help develop curricula for the 21st century and to “build a consensus within the dental community by providing leadership and oversight for a systemic, collaborative, and continuous process of innovative change.”

The words “systemic, collaborative, and continuous” nicely sum up the nature of this enterprise and go a long way toward explaining its far-reaching impact. More on that in a minute, but first, a little history.

“ADEA CCI’s impact on national policy has been unprecedented in the history of our Association, and the reciprocal impact of national policy on how we conduct the business of dental education is already being felt.”

Dr. Kenneth (Ken) L. Kalkwarf, an ADEA Past President and Dean of the University of Texas Health Science Center at San Antonio Dental School who is currently serving as the university’s President ad interim, was asked to be the first Chair of the new commission. In a “Perspectives” piece published later that year in the Journal of Dental Education he observed, “It’s easier to move a cemetery than to change a curriculum,” and he stressed the importance of finding “a single Archimedean leverage point” if systemic change were to occur.

Fortunately, others in ADEA were working concurrently on a project that was well suited to the task of curriculum change. Our current ADEA President, Dr. Gerald (Jerry) N. Glickman, Chair of the Department of Endodontics at Baylor College of Dentistry, was serving as ADEA Vice President for Sections and at the time, chairing a recently formed task force responsible for creating competencies to guide the education of predoctoral dental students. As Jerry tells it, the task force essentially arose from an experience he had while sitting on a committee responsible for writing test questions for National Board Dental Examinations (NBDE).

“I was there to construct endodontic questions, using past tests and several references as guides. The person representing one of the other dental specialties was just pulling his questions out of the air and many of them were not ever covered in a standard predoctoral dental curriculum. At that point, I left feeling like we needed to revise the curriculum guidelines so we could create exams that reflected what we all agreed our students should be learning.”

Jerry brought his concerns back to the ADEA Board of Directors, and, long story short, a decision was made to form a task force to create what we now know of as ADEA’s “Competencies for the New General Dentist.”

This document would soon become the fulcrum for change that Ken was seeking. It not only provided guidance for curricular innovation within our institutions, it also laid the groundwork for major changes to national policy governing dental education.

How?  “We got the right people at the table,” said Dr. Stephen (Steve) K. Young, ADEA’s current President-elect, who recently finished his term as Chair of the ADEA CCI Oversight Committee. “They were willing to step out on a limb and do things differently,” he added.

The right people included representatives of the Commission on Dental Accreditation (CODA), the Joint Commission on National Dental Examinations (JCNDE), the American Dental Association, and the American Association of Dental Examiners, who participated in our effort to develop the competencies, which became an official ADEA Competency Statement in 2008. Along the way, ADEA CCI approached the JCNDE about the teach-to-the-test atmosphere that had arisen at many schools in response to the misuse of NBDE scores to determine entrance to advanced dental programs. The JCNDE appreciated our concerns, and as you know, decided to move to a pass/fail exam. Meanwhile the ADEA Council of Sections began documenting the foundation knowledge that makes it possible to achieve the competencies it identified, and a joint ADEA/CODA task force began meeting to examine and recommend changes to the CODA predoctoral accreditation standards.

This process was almost derailed—both by a desire on the part of some to hold onto the American Association of Dental Schools (now ADEA) curriculum guidelines established in 1992 and by fears on the part of others that ADEA CCI was trying to impose a national curriculum. Over time, those fears were pretty much put to rest. Even schools with similar philosophies have found a wide variety of ways of aligning their curricula with the new competencies and adapting widely admired pedagogical methods to local conditions.

It has been seven years since we launched ADEA CCI, and today we are reaping the fruits of this investment in systemic, collaborative, and continuous change. We have new CODA standards that are aligned with ADEA’s “Competencies for the New General Dentist” and attuned to the need for institutional environments that are conducive to learning. We also have the active engagement of the JCNDE in designing a new integrated exam to ensure that the entire system is aligned.

In short, ADEA CCI’s impact on national policy has been unprecedented in the history of our Association, and the reciprocal impact of national policy on how we conduct the business of dental education is already being felt. The first CODA site visits related to the new standards will begin in 2013. These site visits, and the integrated board exam expected to be implemented as early as 2017, have spurred our schools to examine almost everything they do.

As Dr. Marilyn S. Lantz said half in jest when we met in Chicago, “Terror is a great motivator.” Marilyn is Professor of Periodontics and Oral Medicine at the University of Michigan School of Dentistry and Associate Director for Education, Career Development, and Mentoring, Michigan Institute for Clinical and Health Research. “When I was academic dean, I could always count on getting things done two years before a site visit,” she told me. In her view, these looming deadlines have created a window of opportunity for the advancement of change and innovation. Such advancement is especially welcome around previously overlooked issues, such as diversity.

ADEA CCI has also made our Association a leader among other health professions education associations. Many are envious of dentistry’s move to a pass/fail national exam and are looking for ways to free themselves from having to teach to their own national tests. Others are impressed that competency-based education has become the norm in dental education, and they are coming to us for guidance.

“You are so far ahead of the curve.” Dr. Bryan J. Cook, Director of the Center for Policy Analysis at the American Council on Education (ACE), shared those words at the ADEA CCI Oversight Committee meeting in Chicago. “You’ve had discussions that most of us are just beginning to have.”

I’ve gotten a sense of our leadership while meeting with the North American Veterinary Medicine Education Consortium (NAVMEC), and while speaking to our peers in medicine, nursing, public health, and optometry. They share a desire to see change and innovation take root in their member institutions. In short, ADEA CCI’s work not only benefits the dental and allied dental professions, it also affects more broadly both the health professions and the future of patient care.

What is next for ADEA CCI? We have already begun fostering change and innovation beyond predoctoral dental education. We have formed the ADEA Future of Advanced Dental Education Admissions (ADEA FADEA), and we have begun to extend ADEA CCI’s work to the allied oral health professions, as evidenced by the decision to colocate this year’s ADEA CCI Liaisons meeting with our annual ADEA Allied Dental Program Directors meeting. Next year the two groups will share a plenary session.

In the meantime, ADEA CCI Liaisons will continue to incubate new ideas and build capacity for change at our institutions, and we will do more to engage a broader range of change agents on campus.

“The leadership needs to accept responsibility for carrying on this work,” said Dr. Michael (Mike) J. Reed, an ADEA Past President and former Dean at the University of Missouri – Kansas City School of Dentistry. “They need to make it part of the fabric of the institution as they approach the accreditation process.”

As Marilyn indicated before, the timing couldn’t be much better. I expect the pace of change to accelerate as schools prepare for site visits under the new CODA standards and consider how best to prepare their students for the new integrated exam. The change will be scary for some, contentious for others, but in the end, I believe it will benefit us all. As Mike says, “We have to continue down this road and build upon the productive initiatives we have taken over the past few years.”

I agree entirely, and ADEA is committed to helping everyone to continue moving forward. What is our latest effort to support your journey? In April, ADEA began a series of Regional Accreditation Workshops.  I’ll share more about those next month.