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Dr. Richard Valachovic
In this month’s letter, ADEA President and CEO Dr. Rick Valachovic shares what you may have missed at the 2013 ADEA Annual Session & Exhibition in Seattle, Washington.

Here’s an anecdote that captures the energy at the 2013 ADEA Annual Session & Exhibition in Seattle. I heard it from Monday’s plenary speaker, political commentator Tucker Carlson.

“I spend an awful lot of my life in hotels, and in hotel gyms early in the morning, and I’ve never seen anything like what I saw this morning: 5 [minutes to] 6:00—every machine taken. It was unbelievable. I didn’t know what to do.

“I got back in the elevator feeling kind of flustered, and I immediately run into your Chair-elect of the Board, Lily Garcia. I said, ‘What’s going on? Your gym is full.’ And she said, ‘Well, I’ve already been. You’ve got to get there early.’

“Early?! It’s 6:05!”

Were the ADEA members Carlson marveled at in the hotel gym the same ADEA members I saw crowded into the first-floor wine bar as I headed up to my room most evenings around midnight? I can’t vouch for that, but suffice it to say that Seattle provided almost round-the-clock excitement and an unexpected touch of romance for those who made the trip to the 2013 ADEA Annual Session & Exhibition.

This year marked our Association’s 90th anniversary, which we celebrated during our opening reception with the screening of a short video illustrating some of the highlights in our community’s history. At the opening of the ADEA House of Delegates, I also shared some of the topics addressed at our Association’s first Annual Session in 1923: “The Problem of Teaching Root Canal Technic in our Schools,” “Registration, Examination, Assignment of Patients in General Procedure Followed at First Sitting,” and “Method of Clinical Instruction in the Treatment of Pyorrhea Alveolaris.” I joked that everyone was no doubt glad that we would not be hearing about those topics this time around, and I’m sure they were.

So, what did we discuss? If you’ve ever been to an ADEA Annual Session & Exhibition, you know it would almost be easier to list the things we did not discuss.

Those who arrived on Friday or Saturday could learn about gender issues in the dental curriculum, the meaningful use of electronic health records, and the changing landscape of oral cancer survival. They could acquaint themselves with the best practices in community outreach programs, consider strategies for implementing interprofessional education, and cultivate alliances to strengthen diversity and inclusion on campus. They could start their day by touring the impressive new pediatric dental facility at the University of Washington or devote their morning to acquiring a grasp of the financial management and fundraising skills that every administrator must have. That’s not even half of the offerings available to those who arrived before the opening of the House of Delegates, and the subsequent days were even more jam-packed with diverse programming designed to reach every ADEA constituency.

This year’s theme, “The Landscape of Learning,” lent itself to this inclusive and eclectic treatment, and from my many conversations over the course of five days, the active Twitter feed, and the happy photos posted on the ADEA Annual Session & Exhibition App, it appears that this year’s attendees were delighted with the programming. Submissions were at an all-time high, and the quality of the sessions reflected that.

Another indication that this year’s attendees were satisfied customers? They turned out in droves for the plenary sessions. Sunday’s speaker, scientist and author Dr. John Medina, acquainted us with declarative memory and how it manifests itself in the human brain. This was a great introduction to a fascinating topic that we will explore further next year, when the ADEA Annual Session & Exhibition will focus on “The Science of Learning.” This theme was chosen by our new ADEA Chair of the Board, Dr. Steve Young, Dean of the University of Oklahoma College of Dentistry.

Our other two plenary speakers also drew enthusiastic audiences. Tucker Carlson kept everyone entertained with his unsparing assessments of the Republican Party and the Obama Administration, but he also delivered an important message that ADEA members would do well to heed.

“In contrast to the people I work with,” he told those gathered, “you alleviate suffering. That’s the bottom line of your job. When you go to Washington, I hope you go with that posture. I think people that project that kind of confidence are listened to on the Hill.”

Tuesday’s plenary speaker, Rahaf Harfoush, arrived needing a root canal. I’m pleased to report that we fixed her up with a local endodontist, and she left Seattle in a lot less pain than when she arrived. Her talk focused on how industries and institutions are being disrupted by the unprecedented power of individuals to create change using digital technologies. What impact this change will have on dental education is not entirely clear, but the growth of free, online courses and the existence of a DIY (do-it-yourself) dentistry site that has attracted tens of thousands of visitors should inspire all of us to heed her parting words: “Evolve or die.”

You can read more about these talks and other sessions as well in the April edition of the Bulletin of Dental Education (BDE). There were many other memorable events at the 2013 ADEA Annual Session & Exhibition that I could tell you about—the ADEA GoDental Workshop and Recruitment Fair for Predental Students and Advisors; the 2013 William J. Gies Awards for Vision, Innovation, and Achievement Gala; the ADEA Commission on Change and Innovation in Dental Education College President’s Symposium; or the much anticipated session on current professional students and their educational debt—but you will get a fuller account of these and other sessions in the BDE. For now, let me focus on a few firsts, and bring in that romance I mentioned earlier.

The One ADEA Showcase. Comfortable chairs, fresh fruit, access to information, and knowledgeable staff made this year’s addition to the Exhibition Hall a popular place to rest, refuel, and gather facts and advice about our Association’s member resources. Attendees could meet with MedEdPORTAL authors, explore the Curriculum Resource Center, or learn about the new ADEA Dental Hygiene Centralized Application Service in easy proximity to commercial and educational exhibitors, and the ever-popular lunch buffet.

Susan Dentzer. The editor-in-chief of Health Affairs is not the first professional journalist to grace the ADEA Annual Session & Exhibition stage, but she is the first one to moderate an ADEA Presidential Symposium. This year’s Point/Counterpoint tackled the responsibilities of dental education vis-à-vis emerging dental workforce models and brought together two national figures—Dr. Louis Sullivan, former Secretary of the U.S. Department of Health and Human Services, and Dr. Tyrone Rodriguez, President-elect of the Hispanic Dental Association—and an insightful panel of respondents. Dr. Dentzer did a masterful job of keeping the discussion focused while drawing out different points of view. Another innovation—round table discussion time following the symposium—gave ADEA members a chance to talk face-to-face about emerging workforce models.

A proposal of marriage. If you’re looking for love, the 2014 ADEA Annual Session & Exhibition just might be the place to do some reconnaissance. Dr. Joe Chang and Ms. Jenna Lau connected at our 2011 meeting in San Diego. The resident and student, both at the University of Detroit Mercy School of Dentistry, stayed in touch and, apparently, got to know each other better. At the conclusion of their presentation, “Planting the Seeds of Leadership with a Student Research Program,” Joe got down on one knee and popped the question. Thanks to the ADEA Twitter feed and the next morning’s Daily News, they soon became the talk of the 2013 ADEA Annual Session & Exhibition.

Of course, Joe and Jenna are not the first couple to meet through ADEA. The one I know best has been an integral part of the ADEA staff for many years. As I mentioned when I spoke in Seattle, one half of that pair, Dr. Dave Brunson, former Associate Director for the ADEA Center for Equity and Diversity, retired in February, and his wife, ADEA’s Senior Vice President for Educational Pathways Dr. Anne Wells, will be retiring soon. I also noted the absence of ADEA’s former senior executive overseeing public policy and advocacy, Jack Bresch, who passed away in 2012. Sadly, he was one of several dozen members of the ADEA family who died last year, but who left fond memories with those still in our ranks.

A change to this year’s meeting schedule meant that even delegates and Board members could head home half a day earlier. For those who stayed through Tuesday afternoon, the meeting ended on a high note. During the closing of the ADEA House of Delegates, Dr. Jerry Glickman surprised the crowd by delivering his final speech as President via a professionally produced video, made possible courtesy of Bill Butler of the University of Texas Health Science Center at San Antonio and the Massad Center in Tulsa, Oklahoma. Alongside images conveying the landscape of learning—from the inside of a dental clinic to the inside of a human brain—Jerry shared the highlights of a very full year. His presidency has clearly been a labor of love, and his strong connection with students came through loud and clear.

We then acknowledged our Immediate Past President, Dr. Leo Rouse, whose service on the ADEA Board of Directors had come to an end. To mark the occasion, we presented Leo with an ADEA flag. This form of recognition is a tradition in the U.S. military—where Leo began his long and distinguished dental career—whenever there is a change in command. Leo was visibly moved by the gesture. He thanked those assembled for giving him the opportunity to lead and said he would proudly display the flag in his home.

As always, we have the tremendous work of the ADEA Annual Session Program Committee and this year’s relentlessly upbeat leader Dr. Ron Botto to thank for the success of our annual gathering. I also want to thank Jerry Glickman, whose infectious enthusiasm set the tone for this year’s high-energy event. Finally, I’d like to acknowledge the presenters, staff, volunteers, exhibitors, and sponsors, whose participation and generosity are responsible for the growing popularity of the ADEA Annual Session & Exhibition. Thanks to all of you, it just keeps getting better! Our new Chair of the Board, Dr. Steve Young, and our new Chair-elect of the Board, Dr. Lily Garcia, have a hard act to follow, but if the past is any guide, we will be celebrating their achievements with equal fervor over the next two years.

So I can’t quite say we went without sleep in Seattle, but as you can see, we had more than enough to fill our days. Many took advantage of the new schedule to head out Tuesday evening as a winter storm was rolling in. Most of those who remained were up before dawn the following morning in time to catch flights home. I venture to guess many did the bulk of their sleeping on the plane.

Dr. Richard Valachovic


In this month’s letter, ADEA Executive Director Dr. Rick Valachovic reflects on our Association’s accomplishments over the past 90 years and credits our tradition of coming together to frankly assess and improve the state of our enterprise.

In some ways, 90 years makes a world of difference. In others, not so much.

AADS PRogram Book

A year after our Association was formed in 1923, our predecessors got together in Chicago for their first annual session. If you are not already aware of it, you should know that our Association, then called the American Association of Dental Schools (AADS), came into being on the cusp of a momentous transformation. Despite the existence of many exemplary schools of dentistry at the time, the educational sphere was poorly regulated, often profit-driven, and characterized by uneven quality. Yet by the end of that decade, those problems were largely resolved, with dental education firmly established as a university-based scholarly endeavor.

In 1920, the Carnegie Foundation for the Advancement of Teaching commissioned Dr. William J. Gies to conduct a groundbreaking study that would lay the cornerstone for dental education as we know it today. Dr. Gies presented a preliminary version of his report to the 40 AADS members who attended the Chicago meeting, requesting that they discuss it “freely, frankly and critically.” He went on to state that he would not reply to their criticisms in order to facilitate “expression of direct dissent on every item on which it might be suitably recorded.” After the discussion, Dr. Gies stated that he was both “greatly and gratefully disappointed” that the paper had been so “cordially and magnanimously” received.

I had the pleasure of rereading those proceedings this past month, and it is astonishing how many of the core concerns that motivated Dr. Gies’s recommendations for the reform of dental education are still with us today. True, university-based dental education is now universal in the United States and Canada, but in other respects, we continue to wrestle with some of the same challenges and still embrace many of the values that were on exhibit at that meeting in 1924.

Dr. Gies and his colleagues posed many questions that will likely be uttered again at this year’s ADEA Annual Session & Exhibition. Is the dental profession large enough to serve the public adequately? Are new members of the oral health team needed to extend access to care? What is the proper relationship of dentistry to medicine, and is there room for common curricula? How can dental educators cooperate with accrediting and examination bodies to elevate standards within the profession? Where does the dental school fit within the university structure?

One of the most intriguing items in the minutes from that 1924 meeting was raised by then President Dr. Henry L. Banzhaf. He urged cooperation between medical and dental colleges and cited an example—at his home school, Marquette University—of interprofessional care that bears a striking resemblance to the collaboration currently taking place between nursing and dentistry at New York University.

“Because we have found that many of our patients require complete medical advice,” he told those assembled, “we have employed, for the past eight years, an examiner in our dental clinic who is a physician as well as a dentist.”

In sharing these similarities with you, I don’t mean to imply that we haven’t made progress in the last 90 years. Quite the contrary. I have been a witness to the unfolding of much of our rich history since joining AADS in 1982. I got a closer view when I was elected to the Council of Faculties that year, and I acquired a front row seat when I became Executive Director in 1997.

Part of my keenness to take on this new role stemmed from my awareness that many in our Association were ready for a change. They were eager to see AADS expand beyond its role as a guardian of dental education and become more actively engaged in shaping its future. When I think back to those days, three individuals stand out for their unwavering commitment to seeing our Association fulfill its potential. Last month, I gave each of them a call to reminisce a bit as this anniversary approached.

You won’t be surprised to learn that one of the people on the other end of the line was Dr. Art Dugoni, Dean Emeritus at the School of Dentistry that bears his name at the University of the Pacific. Our conversation ranged all over the map, touching on the many ways ADEA had evolved over the years, improving internally to better serve its members and influencing external audiences to improve the public’s oral health and enhance dental education. Of all the things Art mentioned, what stood out most was the conscious effort of our Association to bring the education and practice communities together.

“It seemed to me and to others,” Art told me, “that there was a huge chasm, ‘the Grand Canyon,’ between the educators and the practicing community symbolized by the American Dental Association (ADA). As a former President of the ADA, I was the catalyst for bringing the two sides together. I felt strongly that both organizations would flourish as partners, so I got both boards to meet with the vision that we would put before us every issue that divided us and every issue that would unite us. That was the start.”

As I hope you know, our relationship with the ADA today is both cordial and collaborative. Our work with the Commission on Dental Accreditation (CODA) on the new standards for predoctoral dental education programs is a testament to how far we have come since our Association was first founded. We also benefit from this strong relationship in a myriad of smaller ways, such as gaining access to the live ADA Education in the Round courses webcast each year from the ADA’s annual meeting.

As those of you who have been around for a while know all too well, together, these collaborations represent a major step forward for dental education, which often found itself isolated in the past. Dr. Dom DePaola, Associate Dean for Academic Affairs at Nova Southeastern University College of Dental Medicine, reminded me of conversations we had about this problem shortly after I became Executive Director. When he was President and Dean of Baylor College of Dentistry in the 1990s, he used to attend the meetings of the American Council on Education (ACE) and the Association of American Medical Colleges (AAMC).

“I never saw anyone from the dental profession there,” Dom told me. “I felt like the lone wolf.” Dom’s concerns dovetailed with my own, and I was delighted to find a fellow ADEA member who was as committed to the relentless pursuit of strategic partnerships as I was. Today, this perspective is widely embraced throughout our Association, and the results are apparent. I am now a  member of the Washington Higher Education Secretariat. Our relationship with the AAMC has borne copious fruit, most notably MedEdPORTAL®, our joint repository for free, online, peer-reviewed medical and oral health teaching materials. ADEA, AAMC, and several other health professions education associations also have come together in recent years to define competencies for interprofessional practice and education and to promote their use. This initiative, the Interprofessional Education Collaborative (IPEC), which continues to gain momentum, thanks in large part to the energy and insights of ADEA members, will likely have a transformative impact on the delivery of health care.

These developments are part of a larger mission, articulated by our predecessors in 1924, to fully integrate dentistry in the health care system. As Dom points out, dentists are in a great position to shepherd patients into the health care system, but doing so means we need relationships with the whole panoply of health professionals: primary care providers, behavioral health specialists, social workers, you name it.

We have a ways to go in making this vision a reality, but we are much closer than we were a decade ago. In the meantime, ADEA can take pride in its work in another vital area: promoting curricular change through the ADEA Commission on Change and Innovation in Dental Education (ADEA CCI).

“I think CCI is really setting the stage for faculty within dental schools to do things differently,” said Dr. Ken Kalkwarf, former Dean of the University of Texas Health Science Center at San Antonio Dental School, where he currently serves as President ad interim. Ken took on the enormous challenge of getting ADEA CCI up and running when it was first founded in 2005. In just a few short years, this initiative has prompted our member schools and programs to think long and hard about their responsibilities in educating tomorrow’s practitioners.

In Ken’s words, ADEA CCI asked, “Is our responsibility foremost to train people technically for practice today, or is it foremost to teach them to be critical thinkers, lifelong learners, individuals who are capable of working within different environments with new information, and continuing to move oral health care forward?”

While our institutions are at different stages in responding to these questions, I agree with Ken that this member-driven initiative has fundamentally changed the philosophy guiding dental education and is now having a major impact on how we examine our students for licensure. We are preparing our students not only for a continually changing health care environment, but also for shifts in the economic, demographic, and scientific landscapes.

There are far too many additional milestones in our collective history for me to summarize here today. Fortunately, we have begun a timeline of contextual milestones in dental education that you can view on our website. Our plan is to expand it over the next decade in anticipation of our Association’s 100th anniversary, and we want you to be a part of that process. Shortly, ADEA member institutions, individuals, and programs will be able to contribute documents and images that chronicle our collective past. We hope that by 2023 our community will have created a comprehensive picture of dental education’s evolution since its beginnings.

This weekend in Seattle, we will gather once again with another full agenda before us. I want to echo the sentiments Dr. Banzhaf put forth nearly 90 years ago:

“Let us approach the work of this, our first session, with enthusiasm. Let us exercise patience with those who honestly differ with us in their opinion. Let us graciously bow to the will of the majority. Let us work out our problems together, work together, pull together. I am optimistic that with our united efforts we are going to attain our object, namely, to make dental education measure up to the exacting demands of modern health service.”

We use different words—health system reform, evidence-based practice, patient-centered care, serving the underserved—to describe what we are striving for today, but in the end, it comes down to the same thing. Every year, and throughout the year, we come together to air our differences, seek common ground, and chart a path forward. Together—with each other and with our allies on a multitude of fronts—we have accomplished so much more than our predecessors could have imagined. I look forward to joining with many of you to carry on this tradition in the days and years ahead.

In this month’s letter, ADEA Executive Director Dr. Rick Valachovic explains why we need to get up-to-speed on evidence-based practice.

Dr. Richard Valachovic

Evidence-Based Dentistry: Time to Extend the Curve

Last December, I was contemplating how to approach this month’s topic when an email arrived from Dr. Phil Stashenko, President of The Forsyth Institute, with an interesting proposition. Would ADEA be interested in collaborating on the development of training programs in evidence-based dentistry for dental educators?

This opportunity couldn’t come at a better time. As we enter an era of increased accountability in health care delivery, evidence-based dentistry, or EBD for short, is becoming imperative. Before I explain why, let me clarify what is meant by evidence-based dentistry.

The term describes the practice of considering three distinct factors prior to treating patients: (1) the best available scientific evidence; (2) the clinician’s judgment based on past experience; and (3) the patient’s needs and preferences. Developing our students’ clinical judgment is and always has been intrinsic to the dental education enterprise. While we need to do more when it comes to teaching our students to appreciate their patients’ perspectives, the patient’s needs and preferences are largely beyond our control. This leaves finding and appraising the available scientific evidence, which is what most educators have in mind when they talk about teaching EBD.

Why has teaching EBD taken on so much urgency? To start with, the amount of available evidence on how best to care for our patients is growing faster than we can absorb it. Hundreds of clinical trials are published annually in dentistry alone, making it impossible to keep abreast of every new scientific finding. Traditional continuing dental education (CDE) courses, while valuable, cannot possibly keep practitioners up-to-date with all the new developments that might be relevant to their practices.

“When we have new knowledge generated daily, we need a better way to keep up,” says Dr. Rick Niederman, a leading guru on EBD. “We need a simple mechanism for self-renewal, self-education, and I think training in evidence-based dentistry provides people with that facility.”

Rick, who is Director of the Center for Evidence-Based Dentistry at The Forsyth Institute, codirects two highly respected courses in EBD. One is a collaboration between Forsyth and the Centre for Evidence-Based Dentistry in England, and the other is a collaboration with the ADA Center for Evidence-Based Dentistry™.

Despite their similar names, these are independent organizations. That said, they share a common purpose: to analyze and share evidence derived from the best scientific research and to equip practicing clinicians with the skills and knowledge they need to apply evidence-based practices in the field.

I called Rick last month to find out what inroads EBD is making in the dental practice and dental education communities. To start with, I wanted to get a sense of how many of us are currently practicing EBD.

“I think everybody believes that they practice evidence-based dentistry, and in a way, everybody does,” Rick told me. “The challenge, however, is how old that evidence is, and what is the level of that evidence? Is it evidence from 20 years ago based on a case report, or is it evidence from today based on a systematic review of 10 randomized controlled trials that include 10,000 people? That’s a big difference.”

As Rick pointed out, variations in dental treatment have been documented in several scientific journals, including the Journal of Dental Education (JDE), indicating that approaches to care are far from uniform. Why, for instance, are only 40% of dentists prescribing sealants when systematic reviews have demonstrated their high effectiveness?

“We don’t do what we could do,” Rick asserts, “because we’re not aware. There’s just too much information to keep up with. Evidence-based dentistry provides a mechanism for distilling out the good stuff.”

While dental educators seem well aware of the importance of EBD, many of our schools and programs are just beginning to integrate EBD in their curricula. This lag is hardly surprising since most faculty members are just now gaining experience in methodically providing evidence-based care. If you are among this majority, fear not. From what Rick tells me, most of us—not just those of us in dentistry, but all health professionals—are in this same boat. Referencing the so-called S-curve, which characterizes the diffusion of innovation, Rick gave me his impression of where the academic community stands in relation to EBD.

“In terms of acceptance, we are well along on the curve, but in terms of application, I would guess we haven’t even gotten to the S-curve.”

I suspect Rick’s impression applies to most places, but not everywhere. Some of our member institutions have made a strong commitment to teaching EBD and are sending their recent graduates into the field with well-honed EBD skills. Our community also boasts some innovative approaches to training established dentists to use EBD. The ADEA CCI Liaison Ledger profiled several of these efforts in two of its 2012 issues, and this month’s JDE has several articles devoted to this topic. With this foundation, I am optimistic that many more of us will be taking steps that will extend the S-curve by the end of 2013.

So what moved Rick to get out ahead of the curve?

“As a dental student, I always had the feeling that the clinical instruction was opinion-based. Consequently, treatment plans varied with each instructor’s philosophy of care. As a result, neither the patient’s needs and circumstances nor the evidence supporting the outcomes and costs of alternative interventions were routinely considered.”

In the 1990s, Rick joined the faculty at Harvard School of Dental Medicine, where he had another revelation that set the stage for his subsequent devotion to EBD. “I came upon a journal, Evidence-Based Medicine, and I thought, ‘Wow! This really makes sense. It translates science in a meaningful way from a clinician’s perspective.’”

Before long Rick booked a trip to England to take a course in evidence-based medicine at Oxford University. Once back at home, he immediately put the training to use as he set about developing a four-year curriculum in EBD at Harvard.

The American Association of Dental Schools, as we were known prior to 2000, gave Rick an award for his development of that curriculum, and the recognition proved a sign of things to come. Rick began collaborating with a colleague in the United Kingdom, Dr. Derek Richards, to develop the intensive EBD course for practitioners that Oxford still offers to this day, and together they cofounded the journal Evidence-Based Dentistry. They also wrote an EBD textbook, which Rick uses in the ADA/Forsyth course on EBD. This one-week intensive course is offered every fall in Cambridge, Massachusetts.

The course provides a wonderful opportunity for individual clinicians who want to become skilled in EBD. While dental educators are welcome and encouraged to take part, Rick and I agree that until a critical mass of faculty members are trained in EBD, it is unlikely to thrive in an academic context. To this end, I hope that we will find opportunities for ADEA to work with our colleagues at Forsyth and other academic dental institutions in moving this field forward. If you want to get a flavor of what can be done on your campus in the meantime, the ADEA CCI Liaison Ledger might be a good place to start.


In this month’s letter, ADEA Executive Director Dr. Rick Valachovic pays tribute to a member of the ADEA family who died last year—Jack Bresch, former ADEA Associate Executive Director and Director of the ADEA Center for Public Policy and Advocacy.

Dr. Richard Valachovic

Remembering Jack Bresch

It’s hard to believe that January 2012 was only a year ago. At the ADEA office, we were busy preparing for the upcoming ADEA Annual Session & Exhibition, while keeping an ear out for the latest political buzz. All eyes were fixed on the Republican candidates competing for the top spot on their party’s ticket. A rapid succession of six debates, one caucus, and two primaries subsequently whittled the field of contenders from six to five and then four in a few short months. As pundits and voters struggled to make sense of each turn of events, there was one man at ADEA who could be counted on to put these developments in perspective. I can still hear his laugh coming from the other end of the hall.

Those of you who knew Jack Bresch, knew that laugh well. It was the telltale sign that Jack was nearby.

Dr. Richard ValachovicJack joined ADEA in 2001 and served as our Association’s senior executive overseeing public policy and advocacy until stepping back to play a senior advisory role to me in early 2012. Unfortunately, he died in September after a relatively brief illness. Jack was a cherished friend and esteemed colleague whose leadership and compassion are greatly missed. So are his winning smile and the frequent twinkle in his eye that let you know he had a fully formed opinion, but for now he would just keep it to himself.

While Jack took his work and ADEA’s mission seriously and represented our community with the utmost professionalism, his warmth and conviviality probably did more to connect him with people—on Capitol Hill, at other associations, and within our member ranks. Jack reveled in bringing disparate groups together to collaborate. He was a mentor to many, a confidant to some, and ADEA’s go-to person on all things legislative. Simply put, Jack enjoyed being with people, and he had a gift for communicating with everyone in a language they could all comprehend.

Jack was a mentor to a succession of ADEA Presidents, starting with Frank Catalanotto, Chair of the Department of Community Dentistry & Behavioral Science at the University of Florida College of Dentistry. The two connected over a decade ago and worked closely when Frank served as Chair of the ADEA Legislative Advisory Committee. Over the years Frank and his wife Jane occasionally socialized with Jack and his wife JoAnn.

“Jack drank Manhattans,” Frank recalled, “and I learned to like them with him. When I stepped down from the ADEA Legislative Advisory Committee last March, I gave Jack a bottle of his favorite bourbon, Maker’s Mark, not knowing that this would be the last time I would see him.”

“We felt a great friendship,” Frank continued. “There was a time when we had some things going on in our family that we needed to talk to people about, and we had those conversations with Jack and JoAnn. We were roughly the same age, but their life experience and willingness to listen was very comforting. I used to joke with Jack that maybe it was a reflection of his chaplain background. He was a great person to talk to.”

I suspect many of you may be surprised to learn that the people skills Jack employed so successfully on Capitol Hill, first as a Staff Director in the U.S. House of Representatives and later on behalf of a series of associations, were cultivated during an earlier career. Jack’s first calling was as a Roman Catholic priest, initially assigned to his native city, Pittsburgh, Pennsylvania, and later stationed in Okinawa, Japan as a U.S. Navy and Marine Corps Chaplain during the Vietnam War. During his time in the service, Jack supervised drug and alcohol rehabilitation programs and worked as a liaison with the American Red Cross. This opportunity to observe health care up close led Jack to develop what would become a lifelong commitment to advocating for health care reform on behalf of people in need.

In his capacity as the Director of ADEA’s Center for Public Policy and Advocacy, Jack championed the cause of oral health and elevated the profile of dental education on Capitol Hill. An invaluable resource in his own right, Jack also cultivated an expert staff on which he heavily relied, and he schooled ADEA members in advocating for their own interests. One such member was Connie Drisko, Dean of the Georgia Health Sciences University College of Dental Medicine. She remembers calling on Jack for advice on graduate medical education (GME) funding issues throughout her tenure at various institutions.

“Everything I know today about GME is because of Jack and Laura Loeb (an ADEA consultant),” Connie told me. “Here in Georgia, I was able to determine that we were underreporting the number of residents eligible to receive GME through the hospital. Once I fully understood the system, our numbers went from 9 to 47. I don’t know the exact impact on our budgets, but it was in the millions of dollars over the years.”

Last year, Jack recruited Connie to serve on the ADEA Legislative Advisory Committee. When I asked her how he persuaded her, she laughed. “He said, ‘Connie, we need you.’ So how could you say ‘no’ to Jack? You couldn’t.”

Jack earned that kind of loyalty because he was equally responsive to others. When Jim Swift, Director of the Division of Oral and Maxillofacial Surgery at the University of Minnesota School of Dentistry, became ADEA President, he told Jack that he wanted to give testimony on Capitol Hill. Jack and his staff set about making that happen, and Jim testified three times before Congress on ADEA’s behalf.

“Jack knew people in the government and they knew him well,” Jim learned. “It was quite clear he was good at making and sustaining those relationships. He was critically important, but not looking for recognition. Just making sure things went the way we wanted them to go. He was very humble.”

Over the years, Jim and Jack became close friends. ADEA Immediate Past President, Leo Rouse, Dean at the Howard University College of Dentistry, also remembers Jack fondly. Although Leo loves to talk about their shared love of neckties, he and Jack shared a much deeper bond that came from their military service. This bond was especially evident when Leo arranged for an ADEA Board of Directors retreat at Walter Reed National Military Medical Center. Jack was pleased that ADEA Board members were able to witness firsthand how the nation’s wounded warriors are cared for.

The last time Leo and many others saw Jack was at the 2012 ADEA Annual Session & Exhibition in Orlando last March.

“Talk about divine intervention,” Leo told me. “At the beginning of the political plenary, I looked out at Jack, and I felt I had to acknowledge him—his experience, expertise, and friendship. We gave him a rousing round of applause. Little did I know that a week later he would be diagnosed with cancer.”

The news came as a shock to all of us, and the rapid progression of his cancer gave us little time to adjust, but Jack did not simply drop out of sight. Current ADEA President Jerry Glickman, Chair of the Department of Endodontics at the Baylor College of Dentistry, expressed his appreciation that Jack made an effort to attend the Board of Directors meeting last summer after he had become ill. “He didn’t say anything,” Jerry recalled. “He just sat there and watched. It was my first Board meeting as President, and I was so touched, just knowing what he was going through.”

Jack touched many of us individually, but his impact on our entire community also bears remembering. When Jack first joined our ranks, ADEA already had an established presence on Capitol Hill, but it was very much restricted to dental and financial aid issues. Jack understood that advocating on behalf of health professions education would require expanding our presence in other political arenas such as hospitals, biomedical research, and access to health care. For more than a decade, he worked diligently to ensure that policymakers both understood the value of oral health to overall health and appreciated the critical role that academic dental institutions play in promoting the health of the public. This was especially apparent in discussions around the Affordable Care Act (ACA), signed into law on March 23, 2010. Jim Swift recalled that day when we spoke last month.

“When President Obama signed the ACA, Jack had the opportunity to attend the signing ceremony,” Jim told me. “It was televised on CNN so I saw Jack standing in the background with his arms in front of him. I texted him, ‘Jack I’m watching you on TV right now.’ He texted back, ‘Just a pleasure to be here.’”

The Supreme Court ruling that upheld key portions of the ACA was issued in June of last year while Jack was still able to hear the news. Although the law is imperfect and its implementation remains unclear, Jack was pleased to see it moving forward. No surprise there. When others chose to rail against imperfections in the political sphere, Jack tended to be philosophical, often quoting the 19th century German politician Otto von Bismarck, who said, “Politics is the art of the possible.”

For those of you who are unable to join us at the service, consider raising a glass to Jack. Perhaps a Manhattan, prepared the way Jack liked them, would be in order. Maker’s Mark, up, no bitters, with a twist of orange.

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.

Dr. Richard Valachovic

It’s traditional at this time of year to focus on sharing some good news, and this Charting Progress won’t disappoint. An event that took place earlier this year at the Arizona School of Dentistry & Oral Health (ASDOH) calls for a celebration. That event was the graduation of six American Indian dental students—a record number both for ASDOH and for dental education.

“When we started the dental school 12 years ago, there were 98 American Indian dentists in the whole United States,” Dr. Jack Dillenberg, ASDOH Dean, reminded me when we recently spoke. “We’ve graduated six in one year. That’s amazing!”

If you know Jack, his enthusiasm won’t surprise you, but I have to agree that amazing is not too strong a word, especially when you consider that only 17 American Indians enrolled as first-year students in all ADEA member dental schools in the fall of 2011. This number may not be exact because students self-identify their race and ethnicity, and a growing number of them report they belong to more than one racial group. Nevertheless, the number is startlingly low, and it is further dwarfed by the magnitude of oral health disparities within the American Indian community.

Investigators from the Center for Native Oral Health Research (CNOHR) at The University of Colorado Denver report that among American Indians—and also Alaskan Natives—preschool children have three times more untreated tooth decay than their general-population peers; adults have significantly more periodontal disease; and nearly a quarter of those over age 65 are edentulous. Reports also indicate that racial and ethnic minority providers are “more likely to serve in minority and medically underserved communities,” so increasing the number of American Indian dentists and other oral health professionals should be part of our efforts to address these disparities.

ASDOH is not the only school making a concerted effort to recruit and retain American Indian students. Creighton University School of Dentistry has had a decades-long relationship with several American Indian communities and currently has 12 American Indian students matriculated. For many years, the University of Oklahoma College of Dentistry invested in a center to support American Indian students academically. The college currently has six enrolled. (Historically, this number has been even higher.)

Nevertheless ASDOH’s 2012 cohort of American Indian dental graduates is  unprecedented, and it has not occurred by accident, but by design. More on that in a minute, but first I’d like to introduce you to two members of the ASDOH class of 2012.

Dr. Zellisha Quam grew up on the Zuni Reservation in New Mexico. Today, she is taking part in an Advanced Education in General Dentistry (AEGD) program at the University of New Mexico (UNM) in Albuquerque, where she plans to work for the U.S. Indian Health Service (IHS).

Dr. Cheryle Singer grew up on the Navajo Reservation in Arizona. Today, she resides in her hometown and works at another IHS facility, the Hopi Health Care Center, about an hour away. Both women recall when they first set their sights on a career in dentistry.

For Zellisha, who was studying biology and chemistry at the University of New Mexico, that moment came while she was shadowing a Navajo dentist at the Albuquerque Area Indian Health Service and became aware of the huge oral health disparities among American Indians. Her sense of herself as a future health care professional was kindled even earlier when she met an American Indian physician for the first time.

“She was a resident in internal medicine so, of course, I was thinking highly of her,” Zellisha told me, “but when she said, ‘I used to herd sheep with my uncles,’ I said, ‘Wow, so did I.’ That was an epiphany. I thought the dream to become a doctor isn’t so big after all. I can do it, too.”

Cheryle—who put her dental hygiene career plans on hold when she became pregnant while at community college—spent eight years as a dental assistant. She thought her boss’s suggestion that she consider a career in dentistry “absurd,” until she met an American Indian dentist, Dr. Craig Bruce, and his wife Diana. They also encouraged her to consider a career in dentistry and connected her with the Society for American Indian Dentists, inspiring her to seriously consider dentistry for the first time.

“I looked into the prerequisites,” she told me, “and basically all I needed was organic chemistry, biochemistry, and my physics so, I was like, let’s try this and see what happens.”

Before long, both women were roommates and first year students at ASDOH. Both freely admit that the first year was stressful. Neither had experience grappling with the high intensity modular curriculum and weekly final exams. While praising the support of other American Indian students who helped them through, Zellisha mentioned being apprehensive at first about the challenges that lay ahead, and Cheryle, who grew up in a very remote area, said she found the city overwhelming. Attending ASDOH was the first time she was not in school with other Navajos, and she longed to speak her language or talk about things going on back home.

“There were times when I did want to quit, when I just wanted to come home,” she told me, but quickly added that the staff and administration were—here’s that word again—amazing. “They made it a point to reach out to me, just assuring me that they’re there to help me succeed. Just having that voice all the time and being able to depend on my director or my advisor, that really made a huge difference and put my mind at ease.”

Recruitment and retention of underrepresented minority students into the health professions is a central priority at ASDOH and its parent institution, A. T. Still University (ATSU). In fact, the University has tapped Dr. Christopher Halliday, another dentist with strong ties to the American Indian community, to lead its new dental school in Kirksville, Missouri. Having served as the Chief Dental Officer of the Indian Health Service for many years, this retired rear admiral from the U.S. Public Health Service will be well positioned to continue the recruitment efforts modeled on ATSU’s Arizona campus.

Given ATSU’s commitment to serving the underserved, it’s not surprising that community-based education has been part of ASDOH’s predoctoral program from the start. Fourth-year students spend 50% of their time in the field, some of them on Indian reservations. ASDOH students also earn M.P.H. degrees. As Jack likes to say, the school is in the business of training community health leaders and, along the way, teaching them to be great doctors, a phrase he acknowledges began with Dr. Arthur A. Dugoni at the University of the Pacific.

That philosophy has informed the school’s admissions policies. ASDOH selects students based as much on their demonstrated willingness and desire to serve the community as on their academic prowess. Their selection criteria show. ASDOH’s first seven classes averaged between 500 and 691 community service hours per admitted student, with some students logging more than 2,000 hours. As for more traditional measures, ASDOH has put dental school within reach of less academically accomplished students by setting its minimum grade point average (GPA) at 2.5, below that of many other dental schools, and deemphasizing the Dental Admission Test (DAT), since minority applicants have typically not scored well on these standardized exams.

But these policies are only part of the reason ASDOH has become a leader in graduating American Indian dentists. Much of the school’s success in this area must be credited to Jack’s decision to invite one man to join the ASDOH team at the school’s inception, and to empower him to recruit American Indian students and mentor them along the way.

It’s tempting to call Dr. George Blue Spruce, Jr. ASDOH’s secret weapon, but neither word feels right. He was highly visible throughout his career—even before he became the nation’s first American Indian dentist in 1956—and he is indisputably a force to be reckoned with. The reason behind Dr. Blue Spruce’s recruitment success? He understands students’ challenges because he himself experienced them.

It’s hard to summarize a career as varied and distinguished as Dr. Blue Spruce’s. (For that I recommend his memoir.) But to appreciate his current role as Assistant Dean for American Indian Affairs at ASDOH, you should know a few facts. In addition to being the first American Indian dentist, Dr. Blue Spruce was tapped to direct the first federal program aimed at recruiting and retaining ethnic minority students in health professions programs in the 1970s. A full 19 years after he himself received his D.D.S., Dr. Blue Spruce helped the nation’s second American Indian dental student graduate in 1975. He has continued to mentor young American Indians, in his position both as a former commissioned officer in the U.S. Public Health Service and as the founder and first president of the Society of American Indian Dentists (SAID).

Like Zellisha and Cheryle, Dr. Blue Spruce remembers the day when he first set his sights on dentistry. A kind man—who was also a community leader—encouraged Dr. Blue Spruce, then a shy fifth grader, in a bicycle race. Turned out the man was the local dentist. Dr. Blue Spruce is also quick to point out that his own remarkable career would not have been possible without his parents’ support. Both attended one of the notorious boarding schools that plucked Indian children out of their home communities and suppressed their languages and cultures in an effort to prepare them for vocational careers and assimilate them into the dominant society.

Dr. Blue Spruce’s parents made a decision early in their married life that all of their children would receive the type of education that would prepare them for college. They enrolled him in a Christian Brothers School, and from there he went on to Creighton University and Creighton University School of Dentistry. Dr. Blue Spruce has only praise for the education he received, but he still vividly recalls the pain of being far from home and the sting of being an object of curiosity as the lone American Indian on campus.

While today’s native students are less likely to be asked if they grew up in a teepee, Dr. Blue Spruce says stereotypes persist. The students he mentors still come to him with astonishing stories of their classmates’ perhaps well-intentioned but ignorant questions.

Homesickness also dogs many of today’s students. As Cheryle told me, ”I thought the hardest part of the whole thing would be getting into dental school, but leaving the reservation and my family, my two daughters to pursue my degree, that was probably the worst part of all of it.”

On the positive side, the desire of American Indian students to remain close to home is part of what propels them to return to their reservations and treat the people who so desperately need their services. Non-Indian dentists choose this path as well and are welcomed by the Indian Health Service, but they rarely bring the language skills and level of cultural sensitivity that characterizes those who are native to the reservation. Those are unique attributes that our schools might choose to recognize as they shape their admissions policies with an eye toward meeting workforce needs and addressing disparities.

“There are very few schools that want to say, look, we need more American Indian dentists, so let’s make accommodations for them to succeed in school,” says Dr. Blue Spruce, pointing out that many American Indian students graduate from high school without the math and physical and life sciences courses needed to be competitive applicants.

Even for those who are educationally prepared, the cost of dental school can be a barrier. (That’s true, of course, for all of our potential applicants.) The good news is that scholarships and loan forgiveness programs are available for American Indian students willing to work for the Indian Health Service for a period of time. The unfortunate news is that many qualified applicants are choosing instead medicine, pharmacy, and non-health professions, such as engineering.

“I’m running into very qualified American Indian students who say dentistry takes too long,” Dr. Blue Spruce told me. “They say, I can get a degree in engineering or one of the other professions in four years or maybe six and make more money than a dentist does.”

Fortunately, Dr. Blue Spruce is not the only American Indian dentist out there recruiting these days. ASDOH has graduated a total 16 American Indian students. Five are engaged in graduate study and the other 11 are working in Indian communities, where they can spread the word about dental careers to their younger counterparts. No doubt the American Indian graduates from other dental schools are doing the same.

“It’s great for the profession, great for oral health,” Jack told me, “because now we have role models and leaders out there who can be ambassadors, who can encourage other young American Indian men and women to come into dentistry.”

So while ASDOH’s success is something we all can celebrate, clearly, much work remains to be done, and dental schools on the whole will have to do more if the number of American Indian graduates is to multiply. Their numbers in this year’s ASDOH graduating class may be amazing, but wouldn’t it be even more amazing to see this success leveraged at schools throughout the United States and Canada? If your school is interested in working to repeat ASDOH’s success, I know Jack Dillenberg, George Blue Spruce, Chris Halliday, and ASDOH’s recent grads will be happy to help.

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.

Dr. Richard Valachovic

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.

In this month’s letter, ADEA Executive Director Dr. Rick Valachovic explores what’s behind the headlines touting the “flipped classroom” and examines how two dental educators are applying this concept in their classrooms.

A Visit to the Flipped Classroom

Dr. Richard Valachovic

It seems as though the education world has fallen head over heels about something called the “flipped classroom.” In the last few months alone, Time, Wired, The Atlantic, and The Chronicle of Higher Education have all examined the topic. A book by the high school chemistry teachers who are credited with coining the term came out this past summer. And none other than Bill Gates—whose private foundation is underwriting numerous educational reform initiatives—has endorsed the use of a flipped classroom.

Whether they call their approach blended, hybrid, inverted, or flipped, those experimenting with content delivery are clearly onto something.

So what exactly is the flipped classroom? At its most basic, this pedagogical model inverts or flips the traditional relationship between homework and schoolwork. Instead of receiving course content through in-class lectures, students first encounter new information at home, most often through video-recorded lectures posted online. Then, teachers use classroom time to clarify and review key concepts or to practice new skills (the ostensible purposes of traditional homework). The idea is to replace the relatively passive experience of listening to lectures with more engaging activities such as problem solving and working in groups. You can find a more detailed description of the flipped classroom on the website of the nonprofit Educause.

I know of few in the dental education community who have embraced the flipped classroom per se, but many ADEA members are focused on better engaging students in the classroom. You can connect with them through the ADEA Community of Interest for Scholarship of Teaching and Learning (SoTL). Some have taken advantage of new technologies, while others have adopted active learning strategies such as problem- or team-based learning.

Among our many proponents of classroom innovation is Dr. Timothy D. (Tim) Wilson. Tim, an Assistant Professor at the Schulich School of Medicine & Dentistry at Western University (formerly University of Western Ontario), teaches anatomy to health professions students in several of the university’s schools. Five years ago, Tim taught Dentistry 5100 Gross Anatomy as a traditional lecture course. Today, he delivers the content in two shorter, compressed courses as part of Schulich’s newly integrated curriculum, and he has flipped the instructional model.

“My goal is for the students to take lead roles within the class. I’m the organizer, but not the boss,” Tim told me. To achieve this objective, he posts between two and six pages of diagrams with explanatory text on the Web prior to each class session. In the classroom, he shares the microphone and the laser pointer with his students, encouraging them to describe and demonstrate various parts of the anatomy being studied. He still displays PowerPoint slides at the front of the room, but rather than describing each diagram, he uses them as anchors for discussion.

Tim didn’t set out to adopt the flipped approach, but he found that his decision to become “a guide on the side” led him in this direction. He also makes frequent use of clickers connected to an audience response system to get a sense of what his students are gleaning from each lesson.

“Now that the class is interactive, I get a better sense of which students are floundering,” Tim told me. Many flipped-classroom advocates cite this benefit, pointing out that without this type of interaction, faculty may not realize that students are struggling until they calculate their final grades.

Dr. Gwen Essex made this same observation after flipping her clinical course for first-year dental students at the University of California, San Francisco, School of Dentistry. The Clinical Professor and Director of Educational Technology adopted a flipped approach to create more course time for clinical activities, but she has derived numerous other benefits from posting her lectures online for students to review prior to attending class.

“It gives them a chance to own their learning,” she reported during a session called Engaging Today’s Learners Through Hybrid and Blended Instruction at the 2012 ADEA Annual Session, which took place this past March in Orlando. “They come in with a better understanding of what I am going to expect and a better opportunity to succeed.”

The flipped classroom seems especially well suited to Gwen’s course, which already had a well-defined active-learning component. Previously, she lectured students about what they would be doing in clinic, demonstrated the activity, and then walked them down the hall (a five-minute trip that she reports invariably took 20 minutes). During the clinical portion of the class, it became apparent that some students had understood the lecture much better than others, but soon class was over, and the next week they were on to a new topic.

With her lectures now posted online along with related articles and a list of expectations for each clinic session, students can prepare at their own pace and come to class with pertinent questions in mind. Gwen fields these and reviews key points in a clinic huddle at the start of class. Following each clinic session, students are expected to reflect on their experiences in an online portfolio where Gwen offers additional feedback and support for student learning.

Gwen believes that, in addition to freeing up a full hour for clinic time each week, her flipped classroom is part of a larger cultural shift in how we teach students. As she asked those gathered in Orlando, “If we want to develop critical thinkers who will continue to learn over the course of their profession, then why are we relying on the lecture?”

That’s a good question, one that Dr. Frank W. Licari, Professor and Associate Dean of Academic Affairs at Midwestern University College of Dental Medicine-Illinois, has wrestled with in recent years. Frank played a central role in developing the recently revised curriculum at the University of Illinois at Chicago College of Dentistry, and he continues to innovate in his current position at Midwestern.

“We’re looking at developing a different type of student, one who thinks critically, who is a self-directed learner,” Frank told me when we spoke last month. “We don’t think those skills can be gained purely in a lecture environment.”

We’ve carefully selected cases that feature controversial topics in dentistry that don’t have a right or wrong answer,” Frank explained, “so that students go through a process of investigating things on their own. There is still a desire on the part of some faculty to get to the answer, to tell students the right way of doing things or at least what they perceive to be the right way. That’s good for today, but what about tomorrow?”

This perception echoes Gwen Essex’s concern that we need to do more to engage students in continuing to learn once they’re out in practice. Doing more to engage students can be challenging for faculty, who are accustomed to directing students toward learning objectives under very real time constraints. These new paradigms challenge many students as well, some of whom prefer to be told what they need to know in the familiar format of the lecture.

In Tim Wilson’s experience, “The passivity of some students is a hard nut to crack.” That said, student response to his flipped classroom at Schulich has been overwhelmingly positive, even garnering Tim several teaching awards.

“Students loved Tim’s course,” said Dr. Richard Bohay, Assistant Director for Academic Affairs at Schulich. “He has their attention. They are engaged in the process. They are responding.”

According to Richard, Tim’s singular focus on the scholarship of teaching and learning sets him apart, but many of Schulich’s faculty members are employing active learning strategies in their classrooms. The dental school’s new, integrated multidisciplinary curriculum, now in its fourth year of implementation, enables students to revisit the most important curricular content through a series of increasingly complex cases.

“Our goal was to get away from teaching the same material five times by five separate individuals in five different courses,” Richard explained. “There is still redundancy, but it’s planned redundancy, and the faculty is more conscious about the way they are delivering content.”

Richard is enthusiastic about incorporating new teaching techniques in courses at Schulich, but he doesn’t dismiss the lecture either. In his view, it remains a useful way of providing students with essential information and emphasizing key knowledge.

“Different areas lend themselves to different techniques,” he told me, “and different teachers are successful with different techniques. All of these things have their place, and if teachers are interested and keen on employing them, they can all be successful.”

This view seems eminently reasonable, and well worth keeping in mind. The recent flood of media coverage surrounding the flipped classroom suggests that some view it as a panacea for solving education’s ills. That is too tall an order for any single teaching strategy. It also strikes me that the emphasis on the use of videotaped lectures by some flipped-classroom adherents may be overly prescriptive, leading educators down yet another dead-end path. As some critics point out, videotaped lectures are still lectures after all, and poorly delivered lectures are no more likely to engage students at home than they do in the classroom.

Nevertheless, those who are experimenting with content delivery are clearly onto something. Whether you call the approach blended, hybrid, inverted, or flipped, it’s hard to argue with courses that give students the opportunity to take in new information at their own pace, encourage them to come to class fully prepared, and create opportunities for interaction among students and teachers. These steps not only better engage students in the classroom, they encourage students to take responsibility for their learning, they help faculty take the temperature of the class as a whole, and they create opportunities to identify students who can use a helping hand. These results are all to the good.

Of course, the ultimate test of the flipped classroom will be whether it can deliver better student learning. Dr. Vincent J. Iacono, Chair of the Department of Periodontology and Division of Endodontics at Stony Brook University School of Dental Medicine recently put me in touch with a member of his faculty who hopes to measure this impact. Dr. Steven M. Zove, Director of Predoctoral Periodontics, plans to develop some assessments to compare retention of specific course content when it is delivered via traditional lecture and when it is delivered in a flipped classroom. I wish him well in this endeavor and look forward to seeing his results.