In this month’s letter, ADEA Executive Director Dr. Rick Valachovic considers the continued importance of bricks and mortar facilities in an era of pedagogical and technological change.
With all the buzz about digital delivery of educational content these days, it’s truly tempting to imagine that we will soon be operating in a seamless virtual world where students will have access to the best instruction from around the globe and earn their degrees while sitting poolside or comfortably in their pajamas.
Up-to-date buildings are still relevant in the 21st century and essential for fully exploiting the latest technologies.
Perhaps one day, MOOCs (massive open online courses), haptic devices, improved simulators, and technologies yet unknown will make this vision a reality. But right now, dentistry remains predominantly a clinical discipline, reliant on contact with patients, instruments, materials, and other tangible resources. As a result, dental education is still firmly rooted in the bricks and mortar of the buildings that house our schools and programs, and we face all the challenges that come from having to maintain, and ultimately replace, our aging physical facilities.
In 2011, ADEA conducted a Dental School Infrastructure and Capacity Survey. Of the 48 schools that responded, 33 reported that their primary buildings were constructed prior to 1980, and only eight said that their primary facility was completed after 2002, when their planners could reasonably have anticipated many of the pedagogical and technological demands of today’s dental education enterprise. These findings suggest that many of our institutions will be undergoing major renovations or initiating new construction in the not too distant future. Indeed, seven of the surveyed schools reported that they plan to replace buildings. Another 13 plan additions, and 16 plan significant renovations.
For those of you faced with a major infrastructure overhaul, I won’t say the challenges aren’t significant, but in speaking with four deans who recently went through this process, I learned that the rewards are far greater than any headaches encountered along the way.
“It’s a reinvigorating process,” said Dr. Jack Sanders, Dean of the Medical University of South Carolina James B. Edwards College of Dental Medicine, which moved into a new 120,000-square-foot building in 2009. “I had a number of faculty that were thinking of retiring, but it breathed new life into them. Revenues have gone up each year by double digits, and patients love the new facility.”
Among this last group are members of the university’s Board of Trustees who were so wowed by the new sterilization system and other technologies seen while touring the building that they signed up to be treated in the college’s faculty practice on the spot!
I heard about similar positive outcomes from Jack’s counterparts in Augusta, Georgia; Iowa City, Iowa; and Houston, Texas. All four projects had common goals:
- Increasing enrollment to meet workforce needs,
- Upgrading buildings to accommodate new technologies in the classroom and clinical facilities, and
- Creating flexible spaces that would support changes in the curriculum, both today, and as education and clinical care evolve in future decades.
During my conversations with these intrepid builders, I kept hearing similar refrains about how their institutions generated enthusiasm and financial support for the projects, all of which are being well received by the people they are intended to serve. The key, not surprisingly, is planning—lots of it.
“You can’t get too much input, whether it be from faculty, staff, students, or alumni,” says Dr. John Valenza, Dean of the University of Texas School of Dentistry at Houston which celebrated this past June the opening of a new $155 million facility for educating dentists, dental hygienists, and dental specialists. “You can’t have too many eyes looking at things and asking questions.”
Dr. David Johnsen, Dean at the University of Iowa College of Dentistry, agrees and adds this additional advice. “Let the discussion run, but then set a time frame to make decisions.” That approach seems to have worked in Iowa City, where the college’s renovation is still underway but on schedule and slightly under budget.
At the Georgia Health Sciences University (GHSU) College of Dental Medicine, Dean Connie Drisko emphasizes prioritizing communication and accountability. “You have to do a lot of education,” she says. “The faculty don’t necessarily know how to read plans, and the architects don’t understand the needs of a dental school.”
To avoid some of the problems she encountered, Connie recommends keeping very detailed minutes of each meeting with the architects and documenting their responses to faculty and staff requests. “Don’t go to the next step until you are sure that the architects understand what it is you want and what it is you will accept,” she cautions.
Under Connie’s leadership, what started out as a $3 million set-aside to renovate a 13,000-square-foot research space eventually turned into a new $112 million facility serving all of the dental school’s clinical needs. Shortly before Connie became Dean, the president of GHSU commissioned a statewide dental workforce study revealing that one in seven Georgians lacked a dentist. These data spurred the university and the state legislature to support Connie’s plan to convert the smaller renovation she inherited into a major building project that would serve everyone’s long-term interests and goals. As the university president put it during the ribbon-cutting ceremony in 2011, the new facility represents “an investment in the health of the citizens of Georgia,” a view that appears to be widely shared.
I was privileged to be present on that occasion in Augusta as well as for the ribbon cutting in Houston and the ground breaking in Iowa City. In all three cases, I was struck by the presence of state and local politicians and others who expressed their sincere appreciation for the indispensable contribution our schools make, both in providing care and in training the next generation of care providers. Although I missed the ribbon cutting in Charleston, Jack Sanders reports a parallel outpouring of support in South Carolina among alumni and other dental professionals.
“When the building opened, about a third of all the dentists in the state showed up,” he told me. “Our president thought maybe a couple hundred would show, and his jaw just dropped when he saw all these people coming in.”
The other memory of these events that remains uppermost in my mind has to do with the buildings themselves. In contrast to my mental image of a traditional dental school, these structures are quite spectacular, with floor-to-ceiling windows, luminous interior spaces, and eye-catching elements, such as the sculptural donor wall in Charleston and the electronic one that does double duty as a movie screen in Houston. The dramatic glass sculpture that hangs in the multistory atrium serving as GHSU’s entry hall is nothing short of dazzling. Without question, these architectural features enhance the experience of patients, students, and faculty, but all that pales in comparison to what the buildings are allowing the people in them to do: change the way they treat patients, educate students, and learn.
In Iowa City, curricular change is uppermost on David’s mind. He welcomes the greater emphasis on thinking and judgment that accompanies the college’s increased use of case- and problem-based learning.
In Charleston, the new facilities have coincided with an overhaul of the departmental structure and clinical instruction. “We were very compartmentalized,” Jack told me. Now implant dentistry, endodontics, and prosthodontics are in a single Department of Oral Rehabilitation, and students treat patients even more comprehensively than they did before.
Meanwhile, the integration of electronic medical records and other digital technologies is dramatically expanding teaching and learning opportunities. Having computer monitors in each operatory allows faculty to call up images and consult with others electronically across floors. An oral and maxillofacial radiologist helps students interpret scans from a CBCT (cone beam computed tomography)scanner on site, and predoctoral students use CAD CAM (computer-aided design, computer-aided manufacturing)technology to work with faculty to design and fabricate restorations.
“The building and the technology have inspired the faculty to think about what’s possible,” Jack reports. “They just convinced me to look at purchasing a software system that employs three-dimensional printing to create partial dentures onsite.”
Advanced technology is also on display in Houston, no more so than in its simulation laboratory (sim lab), a key element that drove aspects of the school’s redesign. The new sim lab goes well beyond the traditional preclinical format focused on practicing techniques.
“We wanted the simulation lab to look like a clinic rather than a lab,” John Valenza explains, “with a networked computer at every workstation. The focal point is to bring the electronic health record into every simulation. Doing so allows us to use simulated patients with demographic records, medical histories, digital radiographs, and photographs so we can teach medical management, ethics, whatever we can imagine, in addition to the technical skills.”
The decision to incorporate this novel use of simulation meant it would be difficult to cram simulation and preclinical labs into one space, as is typically done. “We agonized over that,” Jack told me. “Could we afford to have two fairly huge rooms, one dedicated to simulation, one dedicated to preclinical labs. Our answer was, yes, we need that because our simulation lab is going to be busy five days a week.”
In Houston and elsewhere, new and redesigned buildings are also facilitating increased interprofessional education (IPE). Both Houston and Iowa City feature research spaces shared by dental and medical school faculty. In Augusta, the collaboration with medicine takes the form of a new Education Commons building that will provide flexible and technologically advanced classroom space.
“We’ve designed two classrooms that can hold our large classes (up to 100 students) and be reconfigured for small group learning,” Connie Drisko told be. “We will also have access to the medical school’s simulation clinics, standardized patients, and many small breakout rooms.”
Without a doubt, up-to-date buildings are still relevant in the 21st century and essential for fully exploiting the latest digital technologies. Up-to-date buildings can also advance the pace and enhance the influence of curricular reform in dramatic ways. And the impact of major building projects on the people inside?
While I spoke with David Johnsen, he sat looking out his office windows at piles of steel waiting to be slung into place.
“Right now it’s a lot of logistical work just keeping the faculty up to speed,” he told me, “and since we’re renovating an old building, the transition plan looks like a D-day operation.”
He estimates that the addition, which broke ground in 2010, will take around three years to complete. Despite the disruption, David has heard few complaints and lots of excitement expressed among faculty and staff about what the improvements will make possible.
“Even though we talk nuts and bolts and wires and so forth,” he reflects, “the question you keep coming back to is function, what do you want to do? The purpose is to engage, whether it’s your patients, your students, your faculty, or your staff, and in the best tradition of a university, to engage ideas.”
Isn’t that what all of our schools and programs are striving for in the end? I hope those member institutions that undertake similar efforts in the years ahead will find the endeavor equally rewarding.
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