Are We Patient Enough to Build a Culture of Research and Scholarship?

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic, ADEA President and CEO, offers four strategies, seven steps and a few reflections on ways dental schools can build a culture of research and scholarship.

We’ve talked a lot in recent years about the need for academic dental institutions to pursue research and scholarship. Most of us agree this pursuit is essential if we want dentistry to sustain its status as a learned profession. Yet, building a research enterprise can be challenging. It takes leadership and commitment, and history shows that it also requires patience, even at institutions that make research a top priority.

Those of us who have been around for a while remember that before John Greene, D.M.D., led a transformation that turned the dental school at the University of California, San Francisco into a research powerhouse, the school had been known for its excellence in restorative procedures, especially those using gold alloys. We can also recall that the dental schools at New York University, the University of Michigan and the University of Texas in San Antonio had limited research portfolios before Michael (Mike) Alfano, D.M.D., Ph.D.; J. Bernard (Bernie) Machen, D.D.S., M.S., Ph.D.; and Dominick (Dom) DePaola, D.D.S., Ph.D., respectively, were appointed to deanships. We take for granted that these institutions, among many others, are now research-focused, but it took years—even decades—for them to achieve that status.

Today, Nova Southeastern University College of Dental Medicine (NSU CDM)—the first of the crop of schools that began graduating dental students in the 21st century—is undergoing a similar transformation, now under the leadership of Dean Linda Niessen, D.M.D., M.P.H., M.P.P. “We’d love to be on the list of the top 10 [National Institute of Dental and Craniofacial Research] NIDCR-funded schools,” Linda told me, “and we’re working to get there.”

This quest aligns with Nova Southeastern University’s current investments in research and scholarship. These include the construction of a hospital and the opening of an M.D.-granting medical school that should attract more research-focused specialists to the campus. The university will also open a Center for Collaborative Research later this year and has recruited 20 scientists from the prestigious Karolinska Institutet in Sweden.

At the dental school, Linda is employing several related strategies to foster research and scholarship. First, she is seeking new faculty who are interested in and capable of conducting research. Second, in recognition that research is a collaborative enterprise, she is looking to develop partnerships—both within the university and with outside groups. Third, she is focused on training the next generation—encouraging not only predoctoral students to do research but also faculty to mentor them and each other. Fourth, she is hosting faculty development seminars with leading researchers who can share their expertise.

“That doesn’t mean it’s easy to build to a research program,” Linda told me, “even for established schools. Sometimes people are intimidated by research. Clinicians are often overwhelmed.”

I also spoke with Terri Dolan, D.D.S., M.P.H., former Dean of the University of Florida College of Dentistry (UF COD), and now Chief Clinical Officer and Vice President at Dentsply Sirona. UF COD has been a top 10 recipient of NIDCR funding for more than a decade. Terri said that when she was a junior faculty member at Florida, “There was always a nagging tension between the researchers and the clinicians about who was more important, who was more valuable, and who received more recognition.”

When Terri became Dean, one of her goals was to show how a culture of research and scholarship supports all three legs of the academic stool—teaching, research and service.

In Terri’s view, a successful dental school has a balanced culture and mutual appreciation across the three missions. As Dean, she supported the development of this culture through several strategic initiatives—including the appointment of an Associate Dean for Faculty Affairs—to ensure that faculty were well mentored and took advantage of the National Institutes of Health’s (NIH) Research Career Development Awards and other similar opportunities. During her tenure, the dental school also benefited from an NIDCR Research Enhancement Infrastructure Award. That support provided key resources that got the school “over the hump,” Terri explained.

“There’s no question that it takes resources to establish a top research program,” says Cecile Feldman, D.M.D., M.B.A., Dean of the School of Dental Medicine at Rutgers, The State University of New Jersey. Cecile is making fostering a culture of research and scholarship a priority during her term as the Chair of the ADEA Board of Directors.

Since 2004, extramural research funding through NIDCR has been essentially flat, despite a FY16 increase. The same is true for the other 20 NIH institutes and centers that fund dental research. While other federal agencies, including the National Science Foundation and the U.S. Department of Defense, also provide dental schools with research support, the finite nature of government research dollars makes it difficult for dental schools to grow their research programs.

While some of the newer dental schools are making notable strides in building their research capacity, very few have been successful in obtaining substantial research funding, and many older schools struggle to obtain funding as well.

“NIH does a great job with the peer-review process,” says Cecile, “but it’s hard to argue that there isn’t any bias in the system.” The review panels often have limited expertise in oral health, she points out, and the process is not blinded. “Even if it were,” Cecile adds, “the nation’s top researchers know what is going on around the country. We need to improve the process to make sure the best science is funded.”

Dr. Feldman counsels that dental schools need to wear a policy “hat” when they develop their research projects if they want to be successful in receiving research awards. “Especially when it comes to research funding from government agencies, it’s always about affecting policies, which will improve our nation’s health,” she says.

All aspects of dental education—clinical care, public health, pedagogical techniques—lend themselves to research and scholarship when looked at from the right vantage point. Whether you are a clinician taking part in a National Dental Practice-Based Research Network study for community-based preventive care, or an educator looking for better ways to assess student learning, “You have to train yourself to say, ‘Why did that work? Why didn’t that work? What did I learn from this experience? And what would help us do this better in the future?’” as Dr. Dolan put it when we spoke.

She sees a number of affordable ways schools can reinforce this spirit of inquiry. She suggests they start by putting their electronic health records’ data to work through participation in BigMouth (see the September 2015 Charting Progress).

“It’s not a matter of money,” she says. “The data are there. It’s a matter of faculty time, focus and commitment.”

Terri also recommends taking part in one of many programs designed to expose students to research. Perhaps the best known of these is SCADA, The International Association of Student Clinicians/American Dental Association, which has been funded by DENTSPLY International, Inc. (now Dentsply Sirona) since 1959.

As a former SCADA participant myself, I can speak firsthand to the benefit of these experiences. I am where I am today in my academic career because of the interest in research that my participation in the SCADA program sparked when I was a dental student at the University of Connecticut.

Industry provides another avenue for financing research, as Terri knows well: “There’s an important role for partnerships with industry on university campuses, but people don’t always understand how to make that work. Small Business Innovation Research grants are underused in dentistry, and can be one way to help commercialize inventions and often spin them off or sell them to a company. That’s all scholarship, and it is critical to advancing patient care.”

Cecile agrees, adding that academic institutions seeking industry research dollars need to be strategic. “It’s not about a single project but about a research agenda,” she says. “Schools need to sit down with corporations, think about the future and develop strategic partnerships.”

So what are some other steps that any academic dental institution can take to foster a culture of research and scholarship?

  1. Make clear that the school or program values research and scholarship by incorporating these pursuits in its mission statement.
  2. Get to know others in the university community and develop collaborative partnerships.
  3. Hire research faculty and make sure their presence is visible in both the dental school laboratories and the classroom.
  4. Encourage students to take part in research projects and competitions that expose them to the broader research community.
  5. Collaborate with local chapters of the American Association for Dental Research.
  6. Take advantage of NIDCR grant programs to build the research infrastructure and to educate and support the next generation of dental researchers.
  7. Use sabbaticals and exchange opportunities to keep faculty fresh.

“We also need to think about collaborations between the highly research-intensive schools and the new schools,” Linda Niessen suggests. “There are opportunities for mentoring and partnerships among the schools that we haven’t leveraged to any extent.”

I agree that we could be doing more to help one another, and if we do, I suspect everyone will benefit. As Terri put it, “Observing, asking questions and then working hard to answer them—that’s the fun part of being at a university. When it all clicks, it’s engaging and that’s where you want to be.”

Related content from previous issues of Charting Progress

What Big Data Could Mean for Dental Education

Harnessing the Potential of Saliva

Evidence-Based Dentistry: Time to Extend the Curve

Our Commitment to Research: Past, Present, and Future

When Opportunity Knocks, An Energized Dental Research Community Answers

See also the Fall 2015 ADEA CCI Liaison Ledger: Research—From the Ground Up

1 comment
  1. Ray white said:

    Rick-Very well done essay! It speaks to the benefit and challenges. I could add that the Dean/CEO must also maintain a balance between the clinical/patient care effort and research. None of this is easy, but the outcomes are important. Thanks again for all you do. Ray w

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