Survey Findings Shed Light on ADEA Priorities

In this month’s letter, Dr. Rick Valachovic explores what the 2018 ADEA Survey of Dental School Seniors reveals about ADEA’s work in five key areas.

Each year the annual ADEA Survey of Dental School Seniors offers a contemporary snapshot of the most recent graduating class and provides insights on how we are doing as dental educators. We’ve yet to fully digest this year’s data, but I’ve had a chance to study the numbers we’ve gathered. The data are telling with regard to a few of ADEA’s recent priorities, so I thought I’d give you an early look at what this year’s senior survey reveals about our work in these areas.

Cultivating future faculty

The creation of ADEA Chapters on campuses is our latest initiative aimed at defining the value and appeal of academic careers. Just two years since their official launch, 48 ADEA Chapters now exist across the U.S (47) and Canada (1)—strong growth from 36 chapters at the start of 2018.

Student involvement in the chapters appears to have become mainstream; about a third of respondents indicated that they had participated in their campus ADEA Chapter in some way and most seniors reported that they had attended a chapter event. Other good news: A healthy 10% of respondents reported having held a leadership position, organized an event, or both, with membership on the rise within the ADEA Council of Students, Residents and Fellows.

It is important to thank ADEA Chair of the Board Monty MacNeil for some of this recent progress. Growing the number of ADEA Chapters was one of his top priorities in 2018-19, a message he has delivered far and wide across the ADEA community, and one he underscored at the ADEA Deans’ Conference this past week. Earlier this year, at his direction, ADEA launched a yearlong promotional effort by naming October “ADEA Chapter Month” and providing resources to schools to help them form chapters and support students interested in learning about academic careers. Key resources that support ADEA Chapter Month include a chapter toolkit and a policy brief that articulates the value of the chapters and describes financial programs for students and residents ready to pursue academic dentistry.

Cultivating future faculty is, of course, a primary goal of these activities. Are ADEA Chapters bringing us closer to our objective? The survey data reveal encouraging news—53% of the students who told us about their intentions said they “definitely” or “probably” plan to teach at some point in their careers. Among that subgroup, 95 respondents said they plan to teach immediately after graduation. If this many graduates joined the faculty ranks each year, we’d be well on our way to solving a persistent problem with faculty vacancies, numbering between 200 and 400 since 2005.

For more on this ADEA priority, visit these pages on the ADEA website:
ADEA Chapters for Students, Residents and Fellows
ADEA Academic Dental Careers Fellowship Program (ADCFP)

Licensure

ADEA has invested considerable effort in recent years advocating for changes to the way U.S. dentists and hygienists are licensed, and our Association is not alone. Some individual schools, educators and partner organizations also have taken bold steps to develop new pathways to licensure that would eliminate the need for single-encounter, procedure-based examinations on patients and enable greater mobility for licensed dentists.

Those of you who have been following this critical topic closely will remember that the yearlong postgraduate residency (PGY1) option; Curriculum Integrated Format (CIF) exam; the Objective Structured Clinical Exam (OSCE), adopted from Canada for use in Minnesota; and the California Portfolio Exam (CPE) were initially greeted with skepticism. They remain controversial in some quarters, but today each of these pathways to licensure is well established in at least one state, and a growing number of states accept one or more of these alternatives. With California and New York—two populous states, each with multiple dental schools—in the mix, it’s easy to see why new pathways to licensure impact more and more dental school seniors each year.

As a result, the 2018 survey contains several new questions that reflect these changes in the licensure landscape. What do the answers reveal? While the various single encounter, procedure-based exams administered at the state or regional level continue to represent 75% of the licensure pathways pursued by this year’s graduates, a substantial minority of the class of 2018 pursued or planned to pursue an alternative pathway. Because some individuals seek licensure through more than one pathway, it’s hard to share precise numbers. The survey suggests, however, that as many as 1,500 seniors may have taken advantage of alternatives to regional and state exams in 2018.

That would not have been possible a decade ago, but the survey also tells us that much remains the same. A full 89% of respondents said the second most influential factor in their choice of pathway was that the chosen exam was the only one accepted in the state where they intend to practice.

For more on this ADEA priority, be sure to read next month’s Charting Progress, which will discuss how the Report of the Task Force on Assessment of Readiness for Practice released in September creates a roadmap for change in dental licensure.

Well-being

For the first time, this year’s survey included 16 questions related to student well-being, a topic I addressed in Charting Progress in July 2017. At the time, ADEA was taking steps to respond to rising concerns about burnout, depression and suicide among health professionals and a possible precursor to these problems: student stress.

I’m pleased to report that responses to the well-being questions were high—and encouraging. Almost 90% of responding students indicated that they “always find new and interesting aspects” of their dental school experience, and more than 90% indicated they usually can manage their dental school workload and cope with the attendant pressures.

At the same time, similar numbers of students sometimes feel overwhelmed, and a smaller majority of students report that they often feel “worn out and weary” or “emotionally drained” at the end of the day. These findings suggest that our recent emphasis on student wellness is well placed, and that continued efforts to boost student resilience and well-being are warranted. ADEA remains engaged in this work, through the ADEA Commission on Change and Innovation in Dental Education, through various ADEA councils and as an inaugural sponsor of the Action Collaborative on Clinician Well-Being and Resilience at the National Academy of Medicine.

For more on this ADEA priority, see the American Dental Education Association (ADEA) Statement on Commitment to Clinician Well-being and Resilience.

Serving the underserved

The survey also reveals continued engagement in two areas of perennial concern to ADEA: preparing students to practice interprofessionally and care for underserved populations. Schools have taken a number of steps to enhance student preparation in both these areas, and the survey respondents indicated that those efforts are paying off.

More than 90% of seniors expressed confidence in the preparation they received in the areas of cultural competency, behavioral and social determinants of health, and dental care for LGBTQ and racially, ethnically or culturally diverse groups—populations that are often underserved. Despite feeling well-prepared to take on this effort, only 61% of respondents said they planned to work in an underserved area at some point in their careers. It’s probably worth exploring why the remaining respondents have ruled out this avenue for practice. On a more encouraging note, 645 students indicated they planned to work in an underserved area immediately after graduation.

For more on this ADEA priority, visit these pages on the ADEA website:
Children’s Health Insurance Program (CHIP)
Medicaid Dental Services
ADEA Student Diversity Leadership Program

Interprofessional education (IPE)

Most ADEA members know that we’ve spent much of the last decade encouraging IPE as a means to prepare dental students for collaborative practice. As a founding member of the Interprofessional Education Collaborative (IPEC), we’ve helped define the nature of IPE and support a series of IPEC Faculty Development Institutes and other events that have helped our members implement IPE on their campuses.

Given this investment, it’s not surprising that 82% of this year’s seniors reported taking part in a wide variety of IPE experiences that helped them gain a better understanding of the roles of other health professions in caring for patients.

The survey indicated that 68% of dental students in the class of 2018 interacted with nursing students, 64% with pharmacy students and 44% with medical students during their dental education. Although seniors reported that classroom activities predominated, the survey also showed that more than a third of IPE activities were clinical, and some involved research. Seniors also indicated that they had ample opportunities to engage in volunteer activities with students from other professions. The vast majority of seniors, 83%, agreed that they had benefited from working with other health professions students.

For more on this ADEA priority, visit these pages on the ADEA website:
20 Years Beyond the Crossroads: The Path to Interprofessional Education at U.S. Dental Schools
All Together Now: Realizing IPE at Academic Health Centers
What jumps out at me from the review of data is that a sizable portion of the students who plan to pursue careers in teaching or serving the underserved are ready to implement their career plans. I don’t want to infer too much from the survey findings, but might they suggest that our efforts to move beyond simple exposure to create immersive educational experiences in these areas is giving students the confidence to take the road less traveled?

Dental students’ desire to engage in these pursuits immediately after graduation is heartening. Of course, this will take time; it will be a few years before these graduates have all embarked on their careers, as many of their fellow seniors have moved on to advanced dental education programs. I’m eager to see how the entire class of 2018 takes on the world.
It’s worth noting that this year we piloted a customized version of the ADEA Survey of Dental School Seniors with students at Canadian dental schools. Each Canadian school has its own exit survey, so it may be some time before response rates on the new ADEA survey allow us to gain clear perspective on seniors’ experiences north of our common border. Nevertheless, our Canadian colleagues have expressed a desire to continue working with us to create a fuller picture of dental education in North America. The annual senior survey is one valuable tool in that pursuit.