London, Havana, Québec—A Year of Cross-Border Collaboration

In this month’s letter, Dr. Rick Valachovic describes recent events that are connecting ADEA with colleagues overseas.

Traveling has long been a part of my job, but this year I’ve had a record number of opportunities to do so on behalf of the Association. In May, I joined more than a dozen other ADEA members in London for ADEE/ADEA 2017—the first truly global gathering of dental educators in a decade, and the first such meeting jointly planned by ADEA and the Association for Dental Education in Europe (ADEE).

The highly interactive meeting drew nearly 300 participants from nearly 50 countries in North America, Europe, Asia, the Middle East and Latin America. Attendees were attracted in large part by the rare opportunity to have a full six hours of protected time for substantive, face-to-face discussions with colleagues from around the globe. Although global networking proved to be the overarching theme for the meeting, the conversation also focused on three other topics of broad concern: interprofessional education, technological and scientific discovery, and assessment.

After returning to the States, I called the President of ADEE, Corrado Paganelli, D.D.S., M.D., Professor and Dean of the dental school at the Università degli Studi di Brescia in Brescia, Italy. He spoke to me from his office before jetting off to a site visit in Israel and then to a conference in Malta. He mentioned that he would be traveling to Oman after that and insisted that continually moving between nations was, for him, a pleasure.

This outlook partially explains why he is such a good ambassador for ADEE and an evangelist for greater uniformity in dental education. As Corrado put it, “Dental students may not use exactly the same device or the same technique, but their training must enable them to practice anywhere in the world.”

Corrado has had a ringside seat as a unified Europe has worked for “dental harmonization,” the process of creating a common approach to dental education in Europe. Previously, the Eastern European nations took a “stomatological” approach (dentistry as a specialty of medicine) while the Western ones were oriented toward “odontology” (dentistry as an independent profession). The politics of Europe may have pushed dentistry to harmonize these approaches across the continent, but once that process was underway, Corrado says, it didn’t make sense to limit their vision of dental education to established European models, an attitude that opened them up to the world.

“There are no more borders in dental education,” Corrado believes. “This is felt everywhere.”

Corrado’s statements certainly capture the aspirations of many in our community, but on the other hand, cross-border encounters also underscore the lack of formal, consistent, international standards for dental education and practice. Each country—and to some extent, each school—is adapting its clinical practices and its curriculum to local conditions, factoring in the economics of dental care delivery, the availability of clinical equipment and materials, the cultural norms of patients and student preferences.

Understanding this context is key to understanding the challenges our colleagues face in other parts of the world. As Corrado put it, “You have to go into detail to understand each other and work on difficulties.”

These comments resonated with my own observations during another recent cross-border experience. In April, several members of the ADEA Board of Directors and senior staff traveled to Havana, Cuba, to look at health professions education and health care in a radically different context. It’s one thing to read about the Cuban health system, but it was quite another to see it in person. I’m not sure we would have understood the critical importance of culture in shaping health care in Cuba without that firsthand view.

For starters, it quickly became clear that Cubans consider health care a right, and because their system is entirely government run, they have highly efficient mechanisms in place for delivering integrated, data-driven care. Neighborhood policlínicos (akin to our community health centers) provide integrated primary care to everyone within a designated geographic area, typically a neighborhood. Physicians, nurses and dentists visit patients in their homes and witness for themselves the environmental and social conditions that influence health.

Because every person in the country has access to the health system, Cuba’s population health statistics are not based on projections but on real numbers. Health professionals use the data they gather to categorize patients by level of need. The Ministry of Health uses this information to distribute resources and make truly informed decisions about everything from where to target anti-smoking campaigns to how many hygienists to train to which neighborhoods need a full-time diabetes educator.

Cuba’s health system is an interesting achievement, especially considering the absence of electronic health records to facilitate this work. Yet, despite universal access to care and a strong emphasis on health education, Cubans still experience dental disease. With tobacco use prevalent, they see plenty of oral cancer. They also lack a fluoridated water supply to suppress dental caries, although a fluoride rinse program in the schools keeps their caries rate somewhat lower than the rate in the United States.

ADEA Chief Policy Officer Denice Stewart, D.D.S., M.H.S.A., asked the director of a clinic we visited what would happen if a parent refused fluoride treatment for their child. The look of absolute horror on her face said volumes about how Cuban attitudes toward public health differ from our own. She was incredulous that any parent would refuse treatment, and looked at the interpreter as though he had misinterpreted the question.

We also witnessed some distinct differences when it came to dental education. All Cuban dental schools are government run, and they use a national curriculum. Students who demonstrate aptitude and complete the necessary prerequisites enter dental school directly from high school and spend five years earning their dental degrees. The last two years are spent in supervised practice in one of the community-based clinics.

We spoke with one of the educators involved in the country’s last predoctoral curriculum redesign. She told us that dental students have clinical experiences similar to our own, but dental education in Cuba is decidedly low-tech compared with what occurs on North American campuses. We didn’t see a lot of digital radiography, computer-aided design and manufacturing (CAD/CAM) or advanced surgical equipment. Yet, despite the lack of digital devices and computerized patient records, the country does have an online network, InfoMED, that gives dentists and other providers across the country online access to all the medical libraries in Cuba and throughout the world.

While Cuba is renowned for sending health care teams to countries around the world, the lack of access to the kinds of supplies we take for granted—from dental implants to everyday items such as sutures, prescription drugs and even toilet paper—can frustrate the ability of health professionals to deliver care. We witnessed efforts by one charitable organization to alleviate these shortages, which many attribute to the U.S. trade embargo that has been in effect since 1960.

Given these material needs, it’s easy to imagine how Cuban dental schools might benefit from enhanced cross-border collaboration, and there are also ways we might benefit from continued engagement with our Cuban colleagues. Learning from their use of community-based rotations to enhance students’ understanding of community service and population health is one example that immediately comes to mind, but how we might facilitate such an exchange beyond this initial visit remains to be seen. Even with more established relationships, sustaining the flow of ideas and know-how across international borders can be challenging.

In London, for instance, attendees expressed interest in finding a global mechanism dental educators could use, whether to share resources or to communicate with colleagues about enhancing faculty development, building a curriculum and creating environments that support competency-based education.

Patrick Ferrillo, Jr., D.D.S., Past President of the ADEA Board of Directors and longtime leader in our work, was one of the people who facilitated the discussion in London about global networking. As he noted, dental educators do have one model for global cooperation: the International Association for Dental Research (IADR). That organization has a strong network that has been able to bring colleagues throughout the world together for regional and global meetings, and IADR provides additional ways for members to correspond with one another between face-to-face encounters. “That does not exist on the education side,” Pat rightly points out.

Pat has been involved on the global stage for years, and left the last global congress—a summit in Dublin, Ireland, organized by ADEA in collaboration with ADEE and the International Federation of Dental Educators and Associations (IFDEA)—energized by the prospect of a globally connected community of dental educators. But, he says, tangible activity to translate that goodwill into a global infrastructure to serve as an umbrella for international exchange must begin to take shape.

“Right now, there are no resources out there, and that’s the real challenge,” Pat remarked when we spoke. While researchers can use their research dollars to attend IADR meetings, educators lack a comparable source of funding. Those from the best-resourced schools often find other ways to underwrite their travel; government sometimes helps (participation in the Dublin summit was underwritten in part by a grant from the European Union, for instance); and corporate sponsors typically play a key role in making professional gatherings possible. Indeed, the London meeting would not have been possible without the contributions of our gracious host, King’s College London Dental Institute, and the support of ADEA Corporate Partners Colgate-Palmolive Co. (Colgate Oral Health Network); GlaxoSmithKline Consumer Healthcare; Henry Schein, Inc.; and The Procter & Gamble Company (Procter & Gamble Professional Oral Health); and additional support from FollowApp.Care, LM-Dental, Planmeca, Two-Ten Health Limited, and Liftupp.

A decade from now, we may look back at this period as a watershed for global cooperation in dental education. As I write this, ADEA staff are engaged in our next international foray. A team travelled to Québec City this week to follow up on the initiatives we first discussed last November in Montréal with Canadian dental school deans (see the March 2017 issue of Charting Progress).

Next stop after that, who knows? ADEA has been making a conscious effort to reach out to the global dental education community for some time now (see the October 2016 issue of Charting Progress). And I have no doubt ADEA’s strategic commitment to serve as a collaborative partner in the global effort to improve oral and overall health will continue to blossom in the years ahead.