ADEA’s Global Journey: Next Stop, London

In this month’s letter, Dr. Rick Valachovic previews a groundbreaking overseas meeting and describes other milestones in ADEA’s journey to advance global cooperation in dental education.

Question: What do Uganda, Sri Lanka and Peru have in common?

Answer: You can find Journal of Dental Education (JDE) readers in all three countries—not to mention in scores of others around the globe.

In a single week this past August, JDE articles were downloaded or viewed online more than 100 times in Finland, Turkey and Malaysia. JDE articles were accessed more than 1,000 times in Australia, India and Germany—and thousands more times across another 90 countries. If these statistics don’t confirm the JDE’s role as a vehicle for disseminating knowledge internationally, I don’t know what would.

As impressive as the numbers may be, they represent just one facet of ADEA’s current strategic commitment to “[s]erve as a collaborative partner in the global effort to improve oral and overall health.” In fact, ADEA began looking outward long before these words were enshrined in our strategic directions. In 2005, ADEA cofounded the International Federation of Dental Educators and Associations (IFDEA), and in 2007, our Association met with colleagues from 66 nations at an IFDEA summit in Dublin, Ireland, to launch a new era of international collaboration. Today, that global effort—temporarily slowed by the economic impacts of the recession—is going strong, and dental educators from around the world are looking to ADEA as a valued resource and partner.

In an era of increasing globalization, it comes as no surprise that U.S. dental educators are contributing to change and innovation at both established and newer dental schools on every continent (see the Spring 2015 ADEA CCI Liaison Ledger). Many large U.S. universities now have satellite programs abroad, and a few of these include global outposts of their dental schools. An association known as the Consortium of Universities for Global Health has grown exponentially in recent years, and its Global Oral Health Interest Group was one of the first special interest groups to be approved by that organization.

ADEA is also actively engaged in a wide range of activities that benefit our international colleagues and enlarge our own understanding of dental health and education. We can boast three global initiatives in 2016 alone and a groundbreaking event planned for 2017. Let’s start there, because I hope I can entice some of you to join us in London next spring for ADEE/ADEA 2017—the first joint meeting of ADEA and the Association for Dental Education in Europe (ADEE).

This highly interactive meeting will focus on four themes and give participants an opportunity to take part in shaping the future of dental education. How? Up to six hours of protected discussion time has been set aside so that attendees can engage in substantive discussion and work to develop a consensus around best practices related to four areas: 

• Global networking: The how and why for dental educators
• Interprofessional education: An imperative for dental education
• The impact of new technological and scientific discoveries on traditional dental education
• Assessment in a global context

Senior faculty from both continents will serve as chairs and facilitators for each working group, and a handpicked cadre of junior faculty will serve as rapporteurs, assisting the workshop facilitators in two ways: by participating in the literature review process that will precede the meeting and by writing four position papers that will capture the attendees’ views. These papers are intended to help guide ADEA and ADEE members in responding to the challenges and opportunities that lie ahead for dental education, and I, for one, am excited to see what writing them collaboratively will reveal.

We anticipate that representatives from around the world will attend the meeting, scheduled for May 8–9, 2017. In addition to the working sessions, the meeting will feature:

• A keynote address by medical futurist, university lecturer and widely published author Bertalan Meskó, M.D., Ph.D.
• A reception in the magnificent Governors Hall of St. Thomas’s Hospital in the heart of London.

The call for posters is now open, and registration for the meeting will open by early December. I hope to see many of you there.

The joint meeting builds on our longstanding close relationship with ADEE and the conscious effort we have made for decades to reach out to the global dental education community. In 2016 alone, we added a feature to the JDE website allowing readers to translate the html text of articles into 90 languages—vastly increasing their accessibility to our overseas readers. We hosted a three-day ADEA CareerCon—an online gathering designed with foreign-trained and North American dentists in mind. And we entered into a Memorandum of Understanding with our sister association in Japan, the Japanese Dental Education Association (JDEA). The JDEA represents all 29 Japanese dental schools, and we look forward to sharing our expertise and developing joint initiatives to advance the mission, vision and objectives of each organization.

Where else has this global journey taken us? In recent years, ADEA members and staff have traveled to international meetings in Riga, Latvia; Szeged, Hungary; Bangkok, Thailand; and Poznań, Poland, to name a few. We’ve hosted five ADEA International Women’s Leadership Conferences in Canada, Sweden, France, Brazil and, most recently, in Barcelona, Spain—where we collaborated with ADEE to sponsor an international workshop on global standards for dental education.

Closer to home, we’ve been busy contributing to a thriving virtual community of educators hungry for materials to build or enhance the curricula used to prepare new dentists for practice in their home countries. These educators can avail themselves of a host of free online teaching, learning and assessment resources and materials through:

• MedEdPORTAL^®, our open-access curricular collaboration with the Association of American Medical Colleges.
• ADEA weTeach^®, a user-friendly gateway—launched this past year—providing teaching, learning and assessment resources.
• The ADEA Curriculum Resource Center, a web portal that, in addition to containing high-quality learning materials (curriculum guides, slide decks, bibliographies, case studies and handouts designed to be easily incorporated into faculty-developed courses), also supports the work of dental educators abroad.

As mentioned before, our journal, the JDE, plays a central role in extending ADEA’s global reach. In addition to publishing several dozen articles in recent years that focus on global health, the JDE also provides content specifically aimed at its international readers. Two examples: A 2013 Perspectives piece by two Australian dental educators provides guidance for international authors on scholarly research and writing, and a 2014 paper describes U.S. career pathways for foreign-educated dentists.

While U.S. authors continue to lead in JDE submissions, the journal has seen a steady flow of manuscripts from other shores. Indian and Brazilian authors have averaged 85 and 32 submissions a year, respectively, since 2010, and our colleagues from Canada, Iran, Turkey, China, Australia and Malaysia also have an impressive record of submitting manuscripts for consideration. Submissions from Saudi Arabia have grown at an especially rapid rate—from six in 2010 to 38 in 2015.

ADEA also serves students from other countries through ExploreHealthCareers.org. A leading resource for individuals seeking information about health careers, the website has logged over 340,000 visitors from outside the United States in the year ending August 2016.

Of course, international collaboration lies at the heart of our Association in a fundamental way that we sometimes overlook. Because ADEA represents both Canadian and U.S. dental schools and programs, we are continually prompted to view the issues that confront us through an international lens. Given the position the United States holds in the world, sustaining that outlook can be a challenge for many of us. Fortunately, cooperative agreements and frequent interaction with our sister associations around the world remind us to look outside our borders and engage with colleagues who bring an international perspective to our discussions. I look forward to experiencing this interchange firsthand in London and seeing where our global journey takes us next.

Related content from previous issues of Charting Progress

The Personal Becomes Political: A Global Phase Down of Dental Amalgam
A Small Step for Global Health With Big Implications for Dental Education
Dental Education: An Expanding Universe 
A Warm Day in Adelaide

IPE at the Tipping Point

In this month’s Charting Progress, Dr. Rick Valachovic reflects on the remarkable progress made by those who have championed interprofessional education and where this effort stands today.

Last month, many of us woke to the sad news that Harrison Spencer, my counterpart at the Association of Schools and Programs of Public Health (ASPPH), had died. If you were not privileged, as I was, to know Harrison, this tribute will give you some sense of the extent of our loss. Harrison had a stellar clinical and research career before devoting himself full time to academic public health. In that capacity alone he leaves a rich legacy, including as a champion of interprofessional education (IPE).

Alongside ADEA and four other sister associations, ASPPH was one of the founding members of the Interprofessional Education Collaborative (IPEC). IPEC has seen tremendous growth since its inception in 2009, and its influence in establishing IPE as an integral part of health professions education has become more marked with each passing year. In 2012, the IPEC founders helped sponsor two influential workshops on IPE, organized by the Global Forum on Innovation in Health Professional Education at the National Academy of Medicine (formerly the Institute of Medicine). In 2014, the independent educational accreditation bodies of the six health professions represented within IPEC formed the Health Professions Accreditors Collaborative to further facilitate the ability of our schools to prepare graduates for collaborative practice. Last month, the National Center for Interprofessional Practice and Education recognized IPEC with  a Pioneer Award for creating the IPEC Core Competencies for Interprofessional Collaborative Practice. And this coming year, the Summer Medical and Dental Education Program will become more broadly interprofessional, engaging the schools and students of other health professions under a new name: the Summer Health Professions Education Program. (If you aren’t familiar with this outstanding preparatory program for students who are underrepresented in the health professions, take a look at this earlier issue of Charting Progress.)

Last month I spoke to Lucinda Maine, Ph.D., RPh, Executive Vice President and CEO of the American Association of Colleges of Pharmacy, another IPEC founder, to take stock of where we stand with IPE.

“I believe IPE is at the tipping point,” she said, invoking author Malcolm Gladwell. “Students like it, our accrediting bodies say we will do it, and selectively employers are telling us they need more team-ready clinicians to hire. The demand side will pull us further and further along the path.”

Indeed, that demand is growing, and the progress we’ve made to date suggests we will be able to meet it. Our schools no longer view IPE as an optional luxury, and the proof is that required IPE learning experiences are rapidly supplanting elective ones. A full 92% of medical schools reported having a mandatory IPE experience in 2014, and that same year, 69% of dental schools reported requiring IPE. That is double the figure from just two years earlier.

Other professions have taken note, and they are eager to join us in this endeavor. IPEC responded this year by expanding its ranks to include an additional nine institutional members, most of which had been supporting members of the collaborative since 2011. We held our inaugural Council meeting in June, and the level of engagement was remarkable, reminding me of the energy we founding members felt at the start of this journey.

Back then, two ADEA Past Presidents, Sandra Andrieu, M.Ed., Ph.D., and Leo Rouse, D.D.S., FACD, carried the IPE torch for our Association. Both were involved in drafting the IPEC Core Competencies, which have become the gold standard for developing IPE initiatives since they were published in 2011. To ensure this influential document’s continued relevance, IPEC recently revised it to organize the competencies within a single domain of Interprofessional Collaboration and broaden them to better achieve the Triple Aim framework that is guiding health care reform.

The competencies have been instrumental in firmly grounding IPE in the curricula of numerous health professions schools, but we have another IPEC initiative as well to thank for recent progress. Since 2012, the collaborative has been hosting a series of IPEC Institutes, where teams from participating schools develop curricular ideas they can implement when they return home. To date, these teams have included members from an almost unimaginable diversity of professions—60 at last count—which speaks yet again to the enthusiasm we’re seeing for interprofessional collaboration. (If you’re curious about the non-health professions among our IPE collaborators, see The Changing Face of IPE and Collaborative Care.)

Another ADEA Past President, Ron Hunt, D.D.S., M.S., has been to so many IPEC workshops that the organizers call him a “frequent flier.” His attendance at six workshops in four years says a lot about the challenges of getting IPE off the ground and about the ability of the IPEC Institutes to jumpstart the process.

As Associate Dean for Academic Affairs, Midwestern University College of Dental Medicine-Arizona, Ron was on the first interprofessional team his university assembled in 2012. With an IPE accreditation standard “pointing the way,” the then Dean of the College of Pharmacy funded the expedition of Midwestern senior administrators to attend an IPEC Institute that fall. Ron told me they returned with plans for a first-year course that were “overly ambitious” and soon scuttled when the representative of the medical faculty left the university.

Following a subsequent institute, plans were derailed yet again. The creation of a new college at Midwestern-Arizona and the adoption of a new university accreditation theme shifted university priorities and resources, leaving IPE with limited institutional support. Nevertheless, the pressure on the College of Pharmacy and others to address IPE-related program accreditation standards propelled the process forward.

At a third IPEC Institute, Ron and his colleagues finally hit on a winning idea they could sell back home. The IPE module they developed fit neatly into an existing introduction to the health professions course, and after a successful pilot, the module was expanded to include all entering students on campus.

Building on this initial success, Midwestern sent three more teams to IPEC Institutes. They have developed an IPE experience that brings pharmacy students into the dental clinic to consult with dental students on patient care, and an innovative elective on patient safety that combines online, classroom and community-based learning.

“We could not have done it without the IPEC workshops,” Ron told me. “You get the expertise of the keynote speakers, but probably even more important, you get the concentrated, unobstructed time to work with your team. There are no distractions from students or anything else. Each of the times we attended, we got a lot accomplished.”

The IPEC Institutes are still going strong, with the next one scheduled to begin on October 5.

These developments all suggest that IPE has indeed reached a tipping point. Nevertheless, realizing our collective vision of a flourishing IPE enterprise throughout health professions education will take more time, energy, thoughtful action and resources.

“Many institutions have done a good job of creating classroom and simulation-based interprofessional learning opportunities, but we need to do more to assess IPE and make sure it is relevant to students,” says Jeff Stewart, D.D.S., M.S., Associate Professor in the Department of Pathology & Radiology at the Oregon Health & Science University School of Dentistry. Jeff chaired OHSU’s Interprofessional Initiative Steering Committee for the past five years, and he believes the next push will be to provide more clinical opportunities for interprofessonal learning through patient care.

In October, Jeff will be joining ADEA as Senior Director for Institutional Innovation and Development. In that capacity, he wants to play a role in ensuring that dental and allied dental education remain prominent participants and leaders in the future evolution of IPE, a goal I share.

When I asked Lucinda about the challenges before us, she pointed out that at most of our institutions, the responsibility for IPE still rests on the backs of willing volunteers. “Upper-level administrators need to see IPE as a mission-related activity that requires financial and human resources to sustain over time,” she said.

I couldn’t agree more. Meanwhile, champions like Lucinda, Jeff, Ron, Leo, Sandra and Harrison have been critically important in bringing us to where we stand today. With students, employers and accreditors as our allies, full IPE implementation is no longer a matter of if, but of when.

Related content from previous issues of Charting Progress

The Changing Face of IPE and Collaborative Care
Interprofessional Collaboration Benefits ADEA and Its Partners
Recent Developments on the IPE Front
IPE Is Here to Stay
Paving the Road to Interprofessional Practice
Crossing the Interprofessional Divide 
Interprofessional Practice Can Play Leading Role in an Academic Setting 

Finally, Some Closure

In this month’s letter, Dr. Rick Valachovic discusses the U.S. Supreme Court’s recent decision regarding the use of race as one factor in holistic admissions decisions at the University of Texas at Austin.

June has come and gone, and universities around the country are breathing a collective sigh of relief. The Supreme Court has finally ruled on the role of race in admissions in higher education.

During the just concluded term, the Court revisited the case of Fisher v. University of Texas at Austin (Fisher II) and ruled that the race-conscious admissions program used by the university was lawful under the Equal Protection Clause of the 14th Amendment. The University of Texas at Austin (UT) instituted a holistic admissions program, which allowed the consideration of race as one of many factors in the admissions process. Although the approach to college admissions used at UT is unique, the Court’s decision signaled that the higher education community stands on solid ground when using race as one factor in holistic admission programs.

The Court first heard Fisher (now known as Fisher I) in 2013 but declined to render a decision. Instead, the justices remanded the case to a lower court to determine whether UT’s admissions policy met the standard of “strict scrutiny.” In other words, the justices wanted the lower court to determine whether the use of race-conscious policies achieved a level of diversity in practice that the university could not achieve through race-neutral policies alone. (For a fuller history of the original case, see my August 2013 Charting Progress.) In 2015, the lower court held that the university had indeed met the strict scrutiny standard, and once again, the case went back to the Supreme Court.

In Fisher II, the most recent decision, the Court affirmed earlier rulings that recognized the value of diversity in educational settings. Justice Anthony Kennedy, writing for the majority, stated, “[T]he compelling interest that justifies consideration of race in college admissions is not an interest in enrolling a certain number of minority students, but an interest in obtaining ‘the educational benefits that flow from student body diversity,’” a phrase quoted from the Fisher I decision.

ADEA views the Supreme Court’s ruling as critical to acknowledging the unique value that diversity brings to students, staff and faculty throughout dental education. ADEA demonstrated its commitment to diversity in higher education by signing onto three amicus briefs that were submitted to the Supreme Court in the case (No. 11-345 in 2012, No. 09-50822 in 2013 and No. 14-981 in 2015). Our Association is proud of its leadership role in championing access, diversity and inclusion, most visibly through the promotion of holistic review—a balanced assessment of each candidate’s experiences, attributes and metrics—in admissions to our academic dental institutions.

Since 2005, we have been offering training and technical assistance to member schools in how to implement this approach to screening applicants, and our efforts have had a measurable impact. A noteworthy 93% of dental schools reported that they used holistic review in a 2014 survey of schools of the health professions, and other health professions educators are looking to learn from our example.

In the past year, ADEA staff and holistic review trainers from our member institutions have presented at both nursing and pharmacy education conferences and at schools of veterinary medicine. We will embark on a new chapter in our diversity efforts in October, when we will host two sessions focused on unconscious bias at the ADEA Fall Meetings. In 2017, the University of Michigan and the University of Florida will also pilot unconscious bias workshops modeled after those developed by the Association of American Medical Colleges Learning Lab. These workshops will be customized for our schools and programs and, if the pilot goes well, we hope to make this training widely available by next summer.

The CODA Predoctoral Accreditation Standards include three dimensions of diversity:

• Structural or compositional diversity, which refers to the makeup of the student body, faculty and staff at a program or institution.
• Curricular or classroom diversity, which refers to the presence of content that promotes the integration of skills, insights and experiences from diverse groups in academic settings.
• Institutional or interactional diversity, which focuses on each school’s climate or environment and whether it values diversity and provides opportunity for informal learning among diverse peers.

There is still much work to be done on all three of the fronts designated in the CODA standards, and the Fisher II ruling made clear that the Court will be watching to see whether institutions go about that work in ways that are consonant with their missions and “narrowly tailored” to meet precise goals. Justice Kennedy concludes, “The court’s affirmance of the University’s admissions policy today does not necessarily mean the University may rely on that same policy without refinement. It is the University’s ongoing obligation to engage in constant deliberation and continued reflection regarding its admissions policies.”

Over time, these decisions affect not only our schools, but also the ability of all people, including the uninsured and economically disadvantaged, to access dental care from dental providers from varied cultural backgrounds. These issues are important, within our community and beyond.

Related content from previous issues of Charting Progress

Preparing to Lead in the Post-Fisher Era
Diversifying the Dentist Workforce, One Cohort at a Time
Number of American Indian Dentists Experiences Amazing Growth Spurt
Can a Girl From the Caribbean Find Happiness in Nebraska? Tales from the AAMC/ADEA Summer Medical and Dental Education Program
Math Literacy: A New Civil Right for an Information Age
Getting the Whole Story: A Holistic Admissions Process
Today’s Students-Tomorrow’s Colleagues

 

The Not-So-Sweet Link Between Oral and Systemic Health

In this month’s letter, Dr. Rick Valachovic, ADEA President and CEO, shares new evidence of sugar’s harmful health effects and asks how the dental education community might capitalize on growing public interest in limiting sugar intake.

Public willingness to address the health effects of sugar may be reaching a tipping point. Last month, the city of Philadelphia passed a tax on sugar-sweetened beverages, becoming the first major U.S. city to overcome resistance to such a measure. Berkeley, California’s residents passed a comparable tax in 2014, but according to the New York Times, this liberal enclave’s success was unique. Forty other municipal and state government attempts to pass similar measures all failed—until now.

Philadelphia’s soda tax—which proponents framed not as a public health measure but as a revenue generator for universal preschool—has given hope to advocates who are alarmed about the nation’s obesity epidemic and the growing body of scientific evidence linking excess sugar consumption to a range of systemic ills.

The World Health Organization (WHO); celebrity chef Jamie Oliver; and former Mayor Michael Bloomberg, who attempted to ban the sale of large-size sugar-sweetened beverages in New York City, have all brought much-needed attention to the hazards of sugar consumption, but no one has beaten the anti-sugar drum quite so steadily as Robert Lustig, M.D., M.S.L., a Professor of Pediatrics in the Division of Endocrinology and a member of the Institute for Health Policy Studies at the University of California, San Francisco. Dr. Lustig authored the best-selling book Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease and now serves as President of the Institute for Responsible Nutrition, a nonprofit organization dedicated to reducing the nation’s appetite for sugar.

This past April, Dr. Lustig gave the opening keynote address at the National Oral Health Conference. The title of his presentation was “Tooth Decay and Liver Decay: The Nexus Between Doctors and Dentists.” You can find his slides online if you want a more detailed explanation, but the bottom line is this—added sugars in our diets cause both dental caries and liver disease.

Dr. Lustig doesn’t mince words about the severity of sugar’s impact on human health. In his view, sugar is a “toxic” substance every bit as dangerous as alcohol. He believes public policies should limit the availability of the first just as they do the availability of the second.

I’ll leave it to our endocrinologist colleagues to evaluate Dr. Lustig’s assertions about liver disease, but his points about caries are more than familiar. I saw the effects of sugar first hand as a pediatric dental resident at Children’s Hospital in Boston. It’s hard to imagine now, but the city lacked community water fluoridation at that time, and we saw high levels of childhood caries as a result.

Jessica Lee, D.D.S., M.P.H., Ph.D., Chair and Director of Research for the pediatric dentistry department at the University of North Carolina at Chapel Hill (UNC) School of Dentistry, is outspoken about the need to address sugar’s causal role in tooth decay. She and Beau Meyer, D.D.S., pediatric dental resident, co-authored a commentary in the October 2015 issue of the Journal of Dental Research calling on policymakers to “be courageous” in developing policies to curb sugar intake and urging the scientific community to raise its voice in support of evidence-based policies.

I reached out to get their thoughts on what the dental education community should be doing to raise awareness among students about the effects of sugar on both dental and overall health. Beau, who is currently pursuing a Master of Public Health degree at UNC, told me they would like to see more emphasis on advocacy in the predoctoral curriculum.

“That goes beyond telling students they need to be advocates and meet with their Congressmen,” Beau said. “I’d like to see something that gets down to the nuts and bolts.” He envisions interprofessional workshops, field experiences and informal opportunities to “lunch and learn” that would teach students how to interact with a legislator, make that first phone call, find appropriate resources and build on established relationships between the state dental society and state legislators. But his vision extends beyond these practical concerns.

“Learning how to see beyond the patient in your chair and look at your practice and how it fits into the community as a whole—it’s a different way of thinking,” he told me, “and it’s a challenging way to think.”

Jonathan Shenkin, D.D.S., M.P.H., couldn’t agree more. Jonathan is Clinical Associate Professor in the Departments of Pediatric Dentistry and Health Policy & Health Services Research at the Boston University Henry M. Goldman School of Dental Medicine.

“When I talk to dental students, I beg them not to think of their futures as treating the patients who walk through the doors,” Jonathan told me. “Being able to change policies so you can improve the health of everyone, not just the people who pay you—it’s the most critical thing we teach students.”

Not surprisingly, Jonathan is excited by the implementation of the soda tax in Philadelphia, and believes such measures will begin catching on around the country. He sees an opportunity for dental professionals to join in this effort to curb sugar consumption and hopes it will have the same impact that tobacco taxes had on smoking.

“We have parallel etiology—sugar—for obesity and for tooth decay. This is a great opportunity to engage the public health and medical communities in helping our patients address the obesity crisis and the oral health crisis at the same time. It can only be positive,” Jonathan believes.

I agree, but given all the attention currently focused on sugar’s contributions to obesity and other aspects of overall health, the challenge may be to keep tooth decay in the conversation. There’s no doubt that it deserves the attention of the dental community. In the same issue of the Journal of Dental Research mentioned earlier, two London-based researchers remind readers that “free sugars” (those found in processed foods, syrups and juices) are the principal (and in their view, the only) cause of caries. They argue that our focus on the other factors—fluoride, bacteria—that mitigate and feed the disease, have taken our eye off the primary culprit. The authors conclude, “Dental caries is a diet-mediated disease,” and they add that “to stress the multifactorial effects on the sugars-induced causal process muddies our understanding and misdirects policy.”

Might it also suggest that we need to reevaluate the role of nutrition and its relationship to the oral-systemic connection in our curricula? I called Rebecca Wilder, B.S.D.H., M.S., another Professor at the UNC School of Dentistry who serves as Director of both Faculty Development and Graduate Dental Hygiene Education. She and her colleagues conducted a survey of North Carolina dentists and dental hygienists to ascertain their knowledge, attitudes and practice behaviors related to oral-systemic disease. They found that respondents were generally knowledgeable but often fell short when it came to putting their knowledge into practice.

“In dental hygiene, we’ve observed these connections for years,” Rebecca told me. “To finally have some science to say yes, these connections have been validated, has been a relief in some respects. Now the challenge is figuring out how to incorporate this into patient care.”

She is encouraged by the recent willingness of pediatric dentists to counsel the parents of their overweight patients about the risks associated with obesity, and she sees room in the curricula to encourage similar efforts for oral-systemic disease.

“I could envision an interprofessional course on oral-systemic disease where sugar is discussed extensively. Students would learn about its detrimental effects—not only orally, but systemically—so they could collaborate on patient care and patient education in the future. Once we have evidence-based knowledge, we have to take the onus as professionals to be assertive and talk to our patients about these issues.”

This fall, I’ll be attending a conference sponsored by a coalition of oral health and pediatric groups with support from the Robert Wood Johnson Foundation. The goal of this meeting is to engage the oral health community in efforts to prevent childhood obesity. Judging from the preliminary agenda, sugar-sweetened beverages will take center stage.

As for the value of soda taxes, it’s too soon to know what their impact will be on the residents of Berkeley or Philadelphia, but we might infer a few things from our neighbor south of the border. Mexico leads the world in soda consumption, and its rates of obesity and diabetes are similar to those in the United States. After Mexico instituted a tax on sugar-sweetened beverages at the start of 2014, researchers at UNC and Mexico’s National Institute of Public Health found a 6% drop in soda purchases compared with previous years. Mexican cola bottlers begged to differ, citing rising sales, but the researchers are sticking by their methodology and offer even brighter news for 2015. They say soda sales were 8% lower than pre-2014 averages, and bottled water purchases were up 4%. In the years ahead, I’ll be watching to see whether the incidence of caries falls as well.

Related content from previous issues of Charting Progress

Setting the Record Straight on Fluoride
Managing Caries Risk: A Paradigm for the 21st Century? 

Game Changers? Time Will Tell.

In this month’s letter, Dr. Rick Valachovic, ADEA President and CEO, looks at two trends that are paving the way for individualized learning—virtual reality and serious games.

If you subscribe to The New York Times, you may have recently received something curious in the mail: a sturdy cardboard box with oddly shaped cutouts, strategically placed Velcro tabs and two plastic lenses. The Google Cardboard viewer is remarkably similar to the 3-D viewers that have been around since the dawn of photography, but with one important distinction: Instead of a slot for slides, the box contains a space for a smart phone. Download a virtual reality app such as NYT VR, call up a video on your smart phone and you can use the box to immerse yourself in a virtual world. Look right. Look left. Gaze up. Gaze down. Turn around, and your view continues seamlessly in every direction. Not only is the image before you three-dimensional, your view has no boundaries, like the world itself.

In education, we’ve been using the term “virtual reality” for years to describe artificially created experiences that simulate real-world conditions and allow learners to practice their skills. Role-playing activities of all sorts—even those that were merely text-based or incorporated only still images—once earned this moniker, but as time has passed, we increasingly use the term to denote digital technologies, especially those that strive to replicate the look and sound and even the tactile sensations of an experience.

In 2003, Second Life—the web-based world where many universities and a few dental schools established virtual outposts—began allowing users to log in from their computers and socialize, learn and conduct business with people across the globe. Today, if you’re willing to spend some serious money, the Oculus Rift and its Touch controllers will give you a much more engaging virtual-reality experience. Although the technology is primarily used to play video games at present, some observers predict that its widespread educational applications will not be far behind. According to Fortune magazine, the U.S. military, a pioneer in the use of educational simulation and gaming, is already employing the Oculus Rift to train soldiers to use the Patriot air defense system.

While I don’t know of any ADEA members currently working with this particular virtual reality technology (if you are, please let me know), I just learned that Meharry Medical College School of Dentistry and the Case Western Reserve University School of Dental Medicine have been approved as developer sites for the Microsoft HoloLens holographic simulation technology, which may someday help students visualize anatomic structures and surgical techniques. I’ll be keeping my eyes on that project, slated to begin later this year.

Meanwhile, the use of nonholographic simulation is well-established in dental education and in recent years has become more sophisticated. DentSim—manufactured by ADEA Corporate Member Image Navigation Ltd.—and the other augmented-reality dental-training simulators on the market introduced computer visualization and assessment to traditional preclinical learning. These systems provide precise and immediate feedback—during a procedure and after it is completed—freeing up faculty and allowing students to perform more preparations than they would otherwise be able to. Since practice makes perfect, the advent of computer-assisted simulation represents a major advance over working on typodonts unaided.

The introduction of haptics—the science of integrating the sense of touch into computer applications—has added yet another dimension to simulation in the preclinical arena. ADEA Corporate Member MOOG—working with Academisch Centrum Tandheelkunde Amsterdam (ACTA), a Netherlands-based dental school—was the first to harness this technology for dental education. Their Simodont^® Dental Trainer creates a simulated learning environment in which students can practice a wide range of psychomotor skills and procedures while receiving the same type of feedback provided by earlier virtual-reality simulators. Working with Novint Technologies, our colleagues at the Harvard School of Dental Medicine (HSDM) have developed an advanced prototype for another haptic simulator, the Virtual Reality Dental Training System, which may also be widely available one day.

Haptic simulators represent a significant step forward in simulation fidelity and efficiency. They eliminate the need for typodonts and manikin heads, and most everyone who has tried these systems is wowed by their ability to replicate the feel of dental instruments interacting with different types of human tissue. While some evidence suggests that students trained using haptic devices perform better than their peers, the body of research supporting the use of haptics in clinical education remains limited, and they face another barrier to widespread adoption: their upfront costs.

To get a read on this issue and other advances in learning technology, I called Elise Eisenberg, D.D.S., M.A., Senior Director of Informatics at New York University College of Dentistry, who has been following these developments for years.

“Schools want to know if a given technology will enable more efficient and effective pedagogies,” Elise told me. “Will they improve the economics of delivering education and the potential for student success?”

Even though digital simulation systems obviate the need for purchasing typodonts and other disposable items and reduce the number of faculty needed to assess preclinical performance, they are not widely perceived as affordable—at least that’s the impression of several people with whom I spoke. Issues of cost aside, Elise sees a compelling reason to bring virtual reality into preclinical and specialty education: The generation of students just now entering dental school is seeking a different type of education.

“Generation Z’s approach to learning is much more personalized, not as prescriptive,” Elise says, “and virtual reality allows for that type of learning.”

Generational learning preferences are even more salient in the latest pedagogical trend: gamefication. If you’re not familiar with the concept, this infographic provides a quick introduction. In a nutshell, gamefication is about applying the elements of game play—entertainment, competition, rewards and such—in other contexts. In the educational arena, some innovators are taking inspiration from a medium that the current generation has been steeped in almost since birth: video games.

As early as 2009, ADEA Corporate Member Nobel Biocare USA, LLC worked with a company called Breakaway Games and the Dental College of Georgia at Augusta University to release a role-playing video game called the Virtual Dental Implant Trainer (V-DIT). The game involves both interviewing patients to determine whether an implant would be appropriate and simulating implant placement, giving students a chance to practice dental implant decision-making.

In 2014, our colleagues at the American Association of Colleges of Pharmacy (AACP) undertook an even more ambitious project: the creation of a massively multiplayer online role-playing game (MMORPG) that health professions students can play to develop interprofessional competencies. Mimycx, as the game is called, places students in a futuristic health care setting. Players choose avatars to represent them on screen, and game play resembles what you would find in World of Warcraft or Grand Theft Auto. But the goal—to seek information from the right health professional at the right time to make better patient-care decisions—is decidedly rooted in the world of health care.

“Mimycx is an educational tool to meet students where they are now,” says AACP Associate Executive Vice President Ruth Nemire, Pharm.D., Ed.D., “so they can learn 24/7, so they can learn from each other and so they have a safe environment in which to learn.”

AACP created the game in partnership with the Virginia Serious Games Institute (VSGI), based at George Mason University. Three schools are currently using Mimycx on a research basis, and the partners hope to market it widely, offering it to schools via an enterprise license or directly to students in the same way electronic textbooks are sold. According to VSGI Founding Director Scott Martin, “What we hope is that as more students have access to the game, they will find teammates anywhere in the world who are using it at the same time, just as they would with standard MMORPGs.”

Social interaction is a key element in games, as Elise Eisenberg pointed out when we spoke, so it makes sense to create virtual environments where learners can engage with one another. “I don’t know of anyone currently creating MMORPGs specifically for dental education,” Elise told me, “but it’s not far away.”

In the meantime, I know of at least two dental schools that are harnessing the appeal of digital games to help their students with knowledge acquisition and review. One of these is the University of Pittsburgh School of Dental Medicine, where Associate Professor of Oral & Maxillofacial Pathology Elizabeth Bilodeau, D.M.D., M.D., M.S.Ed., has developed the University of Pittsburgh Dental School Pathology Game. As with most inventions, this game was developed to solve a problem. Elizabeth observed that students typically performed poorly on image-based exams. Their inability to distinguish conditions by their appearance suggested to her that many students would have difficulty applying their oral-pathology knowledge in a clinical setting.

In response, she created a digital oral pathology atlas, working from a colleague’s rich trove of 2×2 slides that no one was using anymore. To get students to take advantage of this resource, she turned the atlas into a game, with a leader board listing top scorers to motivate players to practice and improve their scores.

“I think there’s a lot of promise in gamefication,” Elizabeth told me, “but I’ve learned it’s incredibly challenging to do it well.”

She says creating the pathology game has been a labor of love, and with students handling the programming, it has also required time and patience. Nevertheless, she remains upbeat about the potential of games and other digital initiatives.

“These tools create a safe environment that simulates the clinical environment,” Elizabeth observes. “Students can fail, and you can actually let them fail. There’s a lot to be said for that.”

Michelle Robinson, D.M.D., M.A., is also enthusiastic about the potential of digital games to enhance dental education. The Associate Professor and Associate Dean for Health Information and Business Systems at the University of Alabama at Birmingham (UAB) School of Dentistry recently developed a game for residents in periodontics. Using the Kaizen (Japanese for “continuous improvement”) platform developed at the UAB medical school, Michelle created an online knowledge-review game to prepare the residents for a mock standardized exam. New content was released each morning, and students who played the game daily were rewarded with extra points. The students’ regular practice appears to have paid off. Michelle told me the program director was “floored” by the improvements he saw in exam scores and plans to use the game again next year.

Michelle and her colleagues are analyzing the data they’ve collected and plan to publish it, so I’ll let them share the details with you later, but I want to mention one other observation she made. Students’ use of the game eliminated the need for faculty to conduct general review sessions prior to the exam. As a result, faculty could spend review time answering questions that arose when students played the game.

As Michelle put it, “If technology means your face-to-face time is more valuable, then that’s even better.” Makes sense to me.

Will digital games and virtual reality bring us closer to a future in which learning can occur anywhere at any time, and effectively prepare our students for clinical practice? The jury is still out, but it certainly appears that we’re headed in that direction, and forthcoming research will help us determine how far away that future lies and what types of detours we may take along the way.

Meanwhile, I applaud our colleagues—in industry as well as academia—who are investing their time and energy in breaking new ground. Only through experimentation, bringing new technologies to market and vigorous research can we learn whether it is possible to realize the promise of virtual reality and gaming.

Related content from previous issues of Charting Progress

New Buildings Support the Use of 21st Century Tools

Is Dental Education Ready for MOOCs?

Perhaps Old Dogs Can Learn New Tricks 

The Not So Distant Future: Dental Education in 2050

Catching the Waves of e-Learning and Distance Education

See also the Spring 2014 ADEA CCI Liaison Ledger: eLearning

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Related content from previous issues of Charting Progress

What Big Data Could Mean for Dental Education

Harnessing the Potential of Saliva

Evidence-Based Dentistry: Time to Extend the Curve

Our Commitment to Research: Past, Present, and Future

When Opportunity Knocks, An Energized Dental Research Community Answers

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

A Superlative ADEA Gathering in Denver

In this month’s letter, ADEA President & CEO Dr. Rick Valachovic shares what you might have missed at the 2016 ADEA Annual Session & Exhibition.

It’s hard to believe that just one month ago, I was a mile above sea level, conversing with many of you, celebrating the progress we’ve made on so many fronts and gathering fresh perspectives on the future challenges and opportunities that await dental education

As always, this year’s ADEA Annual Session & Exhibition offered a chance to learn about and discuss myriad topics. These included calibration, communication, collaboration, cultural competency, comprehensive care, course design and CODA accreditation—and that’s just the Cs! Interprofessional education, dental assisting and dental hygiene, evidence-based dentistry and primary care also took center stage. No matter what your areas of interest, you can find links to session descriptions on the 2016 ADEA Annual Session & Exhibition electronic Program Planner. By logging onto the site with your email and Annual Session registration ID, you can also obtain a wealth of presentation materials.

Meanwhile—to give you a taste of the event itself—here are a few standouts:

Most Eye-Catching Attendee: The Big Blue Bear, a 40-foot high sculpture that has been peering into the Colorado Convention Center since its installation as part of a public art program in 2005.

Most Incongruous Sensation: The warmth of the sun that greeted us on Friday and the snow visible on the Rocky Mountain peaks about 60 miles to the west. (We didn’t know how lucky we were. A week later, a blizzard with 20 inches of snow slammed into the Denver Metro Area and Colorado’s Front Range, knocking out power, closing schools and shutting down Denver International Airport.)

Most Unexpected Sight: The parade of young dancers making their way, with parents and costume trunks in tow, to the dance competition at the other end of the convention hall.

Most Rude Awakening: The clock jumping forward an hour Sunday morning.

Most Pleasant Surprise: Only a few marijuana jokes, and one serious presentation—How Marijuana Legislation Is Shaping Tomorrow—on the drug’s oral health impacts.

Biggest Blast From the Past: The reprinted 1924 Annual Session program, distributed at the Opening Plenary.

Most Entrepreneurial Moment: When start-up the Safe-D-Needle (one of eight new vendors to exhibit this year!) took its first order in the Exhibition Hall.

Most Glamorous Event: The 2016 William J. Gies Awards for Vision, Innovation and Achievement, which was accompanied by Tin Brother, a jazzy bluegrass string band that received rave reviews.

Most Awe-Inspiring Talk: Allison Levine’s description at the Opening Plenary of the first American women’s expedition to Mount Everest.

Most Empowering Session: Brenda Allen’s interactive Q&A during the Evening Plenary on Gender Issues.

Most Partisan Moment: The ADEA Political Spotlight, during which Karl Rove and Howard Dean talked about the Affordable Care Act. Rove wants the future to look like Medicare Part D; Dean says the future will look like Massachusetts, with insurers and health systems coming together to function as one.

Most Amusing Remark: That’s a tough one, but I think all the contending lines were uttered by Karl Rove.

Most Tech-Savvy Location: The ADEA Tech Expo, launched as the Technology Fair in 1999, now in its 18th year!

Most Information Conveyed Per Minute: The ever-popular Short Talks session on using emerging technologies to enhance teaching and learning.

Most (Virtual) Distance Traveled: A discussion of best practices for creating high-quality online education for novice learners, graduate students and practicing professionals.

Most Motivating Suggestion: “If we want to drive the best outcomes for our patients, we need to think of ourselves as innovators.” Tuesday’s Plenary speaker Josh Linkner.

Most Gracious Participants: The folks at the University of Colorado School of Dentistry, who offered visitors a terrific tour of their new facility followed by a delicious lunch, and the visitors who waited patiently while staff arranged alternative transportation to the site.

Most Moving Moment: Ron Rupp’s remarks upon receiving the 2016 ADEA Distinguished Service Award. I’ve known Ron for nearly 20 years and already knew how losing the full use of his right hand in a skiing accident changed the course of his career. But hearing him share that story and the joy he has received through his affiliation with ADEA reminded me of how fortunate we are in dental education to have people with so much passion for the well-being of our profession and our community.

Most Globally Cooperative Occurrence: Too many to choose from here. On Monday, ADEA signed a Memorandum of Understanding with one of our sister organizations, the Japanese Dental Education Association, marking an important moment in our effort to expand our collaborations with our international colleagues. There was also a well-attended session discussing dental therapy practices in Rwanda and Minnesota. I must also give a shout-out to our Association for Dental Education in Europe colleagues, who joined us to continue planning for the first joint ADEA/ADEE meeting, to be held in London in May 2017.

Best Glimpse of the Future: Once again, too many contenders in this category for a single pick. The awarding of scholarships to students pursuing preventive dentistry or academic careers? Discussion of an interprofessional clinic run by students at the University of Colorado? Students explaining their posters in the Exhibition Hall? ADEA Student Diversity Leadership Program participants organizing themselves for a group photo on the stairs of the convention center? All these moments were nothing short of inspiring. If these young people are any indication, the future of dental education looks exceedingly bright!

Most Summative Moment: I was with ADEA Past Chair of the Board Lily Garcia Monday evening, and she recounted an experience that captures the essence of our annual gatherings. Over the weekend, she ran into a former dental student. She was delighted to learn that he had matured into a family man and returned to dental school—this time as an educator. As a first-time ADEA Annual Session attendee, he was overwhelmed by the abundance of opportunities, so she guided him to a seminar designed specifically for new faculty. “That’s what it’s all about,” she told me. “Being able to get new faculty the tools they need, keeping mid-level faculty engaged, and keeping the seasoned folks like us energized and involved.” I couldn’t agree more.

Greatest Regret: That not every ADEA member could be with us in Denver. I hope this brief recap inspires you to join us next year in Long Beach, California, where we will endeavor to move Beyond Boundaries.

Breaking the Mold to Spur Innovation

In this month’s letter, Dr. Rick Valachovic, ADEA President and CEO, previews the unique opportunities that await attendees at the 2016 ADEA CCI Liaisons Summer Meeting in New Orleans.

Have you ever thought about dropping an egg from a 24-story building? Have you wondered how you might construct a package to land it safely on the ground?

From time to time, students at the Massachusetts Institute of Technology (MIT) get together, not just to ponder these questions, but to devise and test contraptions that can keep an egg intact when it is dropped from a great height. Given the countless innovations that have emerged from MIT, I think they’re on to something—and so do management gurus, elementary school teachers and others who want to encourage innovative thinking.

This summer, ADEA will take a page out of the Great Egg Drop book when we host the 10th ADEA CCI Liaisons Summer Meeting in New Orleans. This annual gathering brings together faculty who have been appointed by their deans to be agents of change on their campuses. To celebrate the start of a second decade of innovation in dental education and accelerate the pace of change, this meeting will break the mold. Rather than learning about innovation, the Liaisons will take part in the process itself.

The best way to learn is experiential, and this meeting will give the Liaisons the kind of interactive experiences that can position them to better lead change initiatives at their home institutions, including:

• Taking part in several interactive workshops.
• Receiving direct feedback on current projects or ideas percolating on their campuses.
• Having both time and support to refine their ideas.
• Creating roadmaps for future action.

ADEA Chief Learning Officer Anthony Palatta, D.D.S., Ed.D., who has been working with the meeting planning committee to structure the event, sees the new format as a response to the Liaisons’ request to be engaged in projects throughout the year. That request gave birth to a novel idea: inviting Liaisons who attend the June meeting to present posters representing actual or aspirational projects on their campuses.

These posters will not only expose the Liaisons to some of their colleagues’ best ideas, they will also serve as a vehicle for learning how to innovate and how to evaluate innovation.

The competition will occur in three stages that mirror developmental concepts within innovation:

• In Round 1, Learning How to Assess Innovation, each Liaison will be given a rubric and asked to grade each of the posters.
• In Round 2, Making Your Case for Innovation, the 10 teams whose posters receive the most votes will prepare and make five-minute oral presentations, giving attendees a fuller view of their plans. Once again, attendees will decide which of these projects truly breaks new ground.
• In Round 3, Thinking Innovatively, three teams of finalists will engage in a contest that will hone their innovative thinking skills. (No word yet on whether or not this round will involve eggs.)

If you are a Liaison, and the thrill of competition or the opportunity to get your creative juices flowing still hasn’t motivated you to clear your calendar in early June, then perhaps the lure of funding will. The winners of the poster contest will go home not just with their peers’ admiration, but with some seed money they can use to translate their ideas into action or take established projects to the next level.

The process of planting seeds and taking them to fruition will be further explored in a session that kicks off the meeting on Tuesday. The Going Green Model applies the vocabulary of gardening to the process of change. Speaker Jones Loflin will share his views on:

• Creating environments that enable change to grow and thrive.
• Cultivating routines that support new actions and behaviors.
• Celebrating “harvest moments” that motivate additional growth.

The timing of the Going Green presentation will coincide with the closing day of the 2016 ADEA Allied Dental Program Directors’ Conference, also being held in New Orleans in June. This is the third year the two meetings have held a joint overlap session with the goal of building bridges between the allied dental and dental education communities; however, this is the first time the session will be interactive.

The next day, the Liaisons will be in for another treat: a workshop on transformational leadership led by veteran Liaison Frank Licari, D.D.S., M.P.H., M.B.A. Frank authored a seminal ADEA CCI White Paper on the importance of faculty development in supporting curriculum change, and he has more than two decades of experience putting these ideas into practice. While at the University of Illinois at Chicago College of Dentistry, he established a faculty committee and charged it with developing a new curriculum. He has since held leadership roles at two new dental schools: Midwestern University College of Dental Medicine-Illinois and Roseman University of Health Sciences College of Dental Medicine – South Jordan, Utah, where, in his role as Dean, he is continuing to shake up dental education.

In his current position, Frank has drawn on the expertise of executive consultant Barry Pogorel to conduct interactive workshops with Roseman dental school faculty, most of whom are new to academia. At the June meeting, Frank will lead a reflection exercise drawn from these workshops to give Liaisons a taste of the process he is using to help his faculty adapt to new challenges.

“As I was hiring faculty,” Frank recently told me, “the most frequent thing I heard was, ‘I want to teach students what I know,’ and I told them, ‘It’s really not about that. It’s about teaching them what they need to know for the next 20, 30 and 40 years.’”

So far, Frank has put 51 faculty and staff through transformational leadership training, and he believes it has opened their minds and given them a much better understanding of why the traditional lecture format used when they were in dental school is not as effective as case-based learning and other newer pedagogical techniques.

On the last day of the meeting, Geralyn “Geri” D. Crain, D.D.S., Ph.D., Assistant Dean for Educational Support and Faculty Development and Clinical Associate Professor at East Carolina University School of Dental Medicine (ECU SDM) will hold a workshop on how to translate ideas into reality. She knows this area well, having focused her doctoral research on developing a framework for managing change.

Geri first became involved with ADEA CCI while she was working on her doctorate in organizational development and change. Since joining the faculty at ECU SDM as it opened its doors in 2011, she has served as an ADEA CCI Liaison representing that institution. She recently accepted the position of ECU Interim Assistant Vice Chancellor for Interprofessional Collaboration for the Division of Health Sciences, a post that will give her new opportunities to lead and transform her institution.

Like the schools mentioned above, ECU SDM is a beacon of innovation, and its faculty have been exemplary when it comes to executing all manner of novel initiatives—from a groundbreaking model of community-based dental education to the sophisticated use of digital technologies to support active learning and assessment. Geri will have plenty of first-hand experience to draw on as she leads the Liaisons in creating roadmaps for their own innovation initiatives.

Could this process have positive outcomes for every one of our dental schools? We’d like to think so, but the results depend on participation. We’re hoping every school will send its Liaisons to New Orleans in June. This unique gathering is one your school will not want to miss.

Related content from previous issues of Charting Progress:

ADEA CCI: Curricular Change and Then Some

Jumping Into the Water With Both Feet

New Accreditation Standards Affirm a New Direction for Dental Education

The Not So Distant Future: Dental Education in 2050

Preparing Now for the Future of Dental Education

Commission on Change and Innovation in Dental Education

Leadership Development: ADEA’s Long-Term Investment in Dental Education

In this month’s letter, Dr. Rick Valachovic, ADEA President and CEO, describes ADEA’s current leadership development programs, plans for future opportunities and the reasons these investments matter.

If you could spend a few days looking at the world through the eyes of a theoretical physicist, exploring the virtues of courage and hope, reflecting on your own personal development and gathering the collective wisdom of your peers on a thorny problem at work, would you seize that opportunity?

Leadership development may sound abstract and impersonal, but it is anything but. Well-designed programs offer an immersive experience that challenges participants both personally and professionally, and the results are impressive. ADEA’s decades-long investment in leadership development has yielded a cadre of dental educators who are extraordinarily well-prepared to lead our institutions. These individuals have also been influential in guiding our Association and the course of dental education. As we seek to navigate the challenges of training the next generation of dental professionals for 21st-century practice, the value of investing in leadership cannot be overstated.

“Everyone has to lead at some point, so it strengthens dental education when we prepare our members to lead and to see themselves as leaders,” says Diane Hoelscher, D.D.S., M.S., ADEA’s Senior Vice President for Professional Development. In that position, Diane oversees a continuum of leadership programs tailored to meet the needs of dental educators of all kinds at every stage of their careers.

I hope by now most of you have heard of the ADEA Leadership Institute, our flagship professional development program for faculty who are ready to enter the senior leadership ranks. The institute started in 1999, when multiphase, yearlong programs for health professions educators were few and far between. The program’s duration is important, because research indicates that the best way to change adults’ behavior is to work with them over an extended period of time.

“A yearlong program requires a great deal of commitment from the participants as well as the Association,” says N. Karl Haden, Ph.D., a former ADEA staffer and current President of AAL, which has contributed to the design and implementation of the institute since its inception. According to Karl, 75% of ADEA Leadership Institute alumni say that the program had a significant or highly significant impact on their careers, and 99% say they would recommend the institute to their peers.

In recent years, ADEA has also developed programs tailored to early- and mid-career faculty:

• The ADEA Summer Program for Emerging Academic Leaders, targeting faculty members who have been at their institutions fewer than three years.
• The ADEA/AAL Compass Program for Academic Advancement, an online course that gives early- and mid-career faculty an understanding of how to advance within higher education.
• The ADEA/AAL Chairs and Academic Administrators Management Program, which includes one-on-one coaching for department chairs, program directors and academic managers.
• The ADEA Allied Dental Faculty Leadership Development Program, which is a biennial program specifically geared to the needs of allied dental educators who are interested in eventually becoming program directors.

I should also note that over the years, ADEA has partnered with others on two programs with a long record of achievement. Starting in 2004, ADEA teamed up with the W.K. Kellogg Foundation^® to offer grants to 11 universities through the ADEA W.K. Kellogg Foundation Minority Dental Faculty Development (MDFD) Program. To meet the program’s goal of diversifying the community of dental educators, MDFD supported leadership development for underrepresented minority and low-income individuals recruited to faculty positions. The latest phase of the program builds on lessons learned and provides diversity leadership training and skills development for academic/community partnerships to improve access to both careers and health care for underserved communities.

In 1997, ADEA also partnered with the Hedwig van Ameringen Executive Leadership in Academic Medicine^® (ELAM^®) Program for Women to give dental faculty access to this exemplary program. This collaboration is at least partially responsible for the remarkable rise in the number of women who are dental school deans—13 as of today—or who hold higher positions within their universities.

But our Association is not resting on these accomplishments. Since mid-2014, an ADEA Commission on Change and Innovation (ADEA CCI) in Dental Education workgroup with the American Dental Hygienists’ Association (ADHA) has been helping to create a leadership course for dental hygiene educators. It combines a single two-day, face-to-face session with online networking and instruction to make the course both affordable and accessible. Still in development, the ADEA CCI workgroup with the ADHA will begin piloting the 12-week course in August.

Although ADEA leadership development programs are open to all members, allied dental educators often lack the institutional financial support that facilitates participation in leadership programs that require travel or a major time commitment. This new offering aims to fill that gap.

Meanwhile, just last month, 20 ADEA members traveled to Florida to take part in the inaugural programming for the ADEA Leadership Institute Phase V—an opportunity for institute alumni to reinforce networks, strengthen relationships and engage in further leadership development. Participants had high praise for the three sun-filled days they spent exploring the nature of the physical universe, contemplating virtues that can guide leadership, discussing colleagues’ professional challenges and envisioning their own personal pathways.

Looking ahead, ADEA staff are working on creating a cutting-edge program specifically for new dental school deans. A growing number of dental educators are taking unconventional paths to their leadership positions, and many have requested additional professional development and support.

ADEA also offers less formal ways for its members to develop their leadership skills. As Diane Hoelscher put it when we spoke recently, “The ADEA Leadership Institute gave me what I needed to move into a position as a chairperson, but ADEA also provided me with a great opportunity to lead in the Association.”

Diane first became involved with an ADEA Special Interest Group and served on its board. Seeing that leadership positions within the Association were both “very doable and rewarding” whetted her appetite for more. She was elected as a representative to the ADEA Council of Faculties, served on the Council’s administrative board and eventually became Board Director for Faculties. She found that experience unusually rewarding and instructive. “When you’re doing it, you’re learning by doing,” she observes, “and you’re learning in a way that sticks with you.”

Experience has also been a powerful teacher for ADEA Senior Scholar in Residence Leo Rouse, D.D.S., FACD. Most of you know Leo from his service as President of the ADEA Board of Directors. What you may not know is that Colonel Rouse had a distinguished 25-year career in the U.S. armed forces and served as Commander and Chief Operating Officer of the U.S. Army Dental Corps before becoming a civilian dental educator.

No one is more passionate about the value of leadership than Leo. The former Dean of the Howard University College of Dentistry puts that passion to work by mentoring a cohort of ADEA Leadership Institute fellows, an experience he calls one of the greatest of his professional life.

“Leadership is about the two Cs, communication and collaboration,” Leo says, “and how you look for the good in every person, especially those who may feel they don’t have the requisite skills to do certain things.”

When I asked Leo what lessons about leadership dental education could take from the military, he was quick to focus on mission.

“In academe,” Leo told me, “you have two missions: to educate students and to provide quality, safe patient health care. But faculty and administrators don’t always focus on the macro picture. Often times we think in terms of silos.”

Leo attributes his success as Dean to encouraging faculty to keep the college’s larger mission in view, and he urges other dental educators to keep an eye on the big picture, too. I share that view. No matter where each of us stands in our careers, leadership means remembering that we are part of a larger whole. Whether that entity is our class, our department, our program, our college or our university, we need to ask how we are contributing to the well-being of that whole and how our actions might influence its trajectory moving forward.

As Diane put it, “Leadership is important because of where we want to go and what we want to see happen. Change is a reality in life, but we want to be leading change in the right direction. The more leaders we have in the ranks of dental schools and allied programs, the more capacity we will have to realize our vision for the future.”

I couldn’t have said it better myself.

Next month, many of us will meet at the 2016 ADEA Annual Session & Exhibition in Denver to collaborate on “Shaping Tomorrow, Together.” I hope to see you there.

Related content from previous issues of Charting Progress:
– Who Will Teach The Next Generation?
– Wanted: Jack of All Trades and Master of Many
– From 0 to 13 in 13 Years: ELAM’s Impressive Track Record in Preparing Women for Leadership
– Tomorrow’s Leaders: Made, not Born

Fresh Perspectives on Student Debt

In this month’s letter, Dr. Rick Valachovic shares principal findings from an encouraging recent analysis of student indebtedness and considers the study’s implications for dental education.

Hold on to your hats. When it comes to student indebtedness, the picture may be far less bleak than we’ve been led to believe.

“[T]ypical borrowers are no worse off now than they were a generation ago,” write Beth Akers and Matthew Chingos in a 2014 report published by the Brown Center on Education Policy at the Brookings Institution. Beth, a Fellow in the institution’s Center on Children and Families and at the Brown Center on Education Policy, spoke about the report, Is a Student Loan Crisis on the Horizon?, at the ADEA Deans’ Conference last fall. What she had to say was both startling and reassuring.

The report’s findings (updated) upend the conventional wisdom that is bandied about in the popular media—that increased levels of student indebtedness for all types of students are condemning the current generation to a bleak future. Accounts of excessive borrowing and personal hardship give the impression that all of today’s students are suffering. Beth’s research tells a far different story.

Using 1989–2010 data from the Survey of Consumer Finances administered by the Federal Reserve Board, she and her co-author looked at how educational borrowing levels and incomes evolved within households led by adults aged 20 to 40. Not surprisingly, the authors found a significant rise in the level of student loan debt these households carried and a considerably smaller increase in annual household incomes. But while many people look at these data and jump to the conclusion that today’s holders of student debt are worse off, Beth and her colleague conclude that, “Increases in debt may be a benign symptom of increasing expenditure on higher education.”

“The right way to think about debt,” Beth told me, “is that debt is used to finance an investment that pays off over the lifetime. Your debt may have increased by $5,000 and your income by only $1,000 a year, but when you add it up over a lifetime, that additional income swamps the increase in debt you’ve taken on.”

When it comes to dental education, this finding supports a view I have long held: that dental education is an excellent investment despite its high cost. There’s no question that debt-to-income ratios have been rising in dentistry and other high-income professions in recent years. A paper published in the Journal of the American Dental Association (JADA) in November found that the average educational debt held by dental graduates was 103% of median income in 2011, up from 70% in 1996. But while this percentage represents a significant increase, it doesn’t negate the bigger point made by the Brookings study: that increases in average lifetime earnings have “more than kept pace” with increases in student borrowing.

Indeed, the Brookings report finds that about one-quarter of the rise in student debt over the two decades studied is attributable to the fact that more Americans are seeking higher education and that more of those individuals are pursuing graduate degrees.

“Prior to this paper, people were looking at debt burden in terms of the debt-to-income ratio, but to me the burden of debt is much more appropriately measured by looking at how much you have to pay in a given month to service that debt versus how much you have to spend on consumption,” Beth explains. “That’s the debt payment-to-income ratio that we published. The popular narrative would have you believe that households are being swamped by these payments, but on average, people are spending about 4% of their monthly earnings on debt repayment.”

According to Beth, that number has not increased over time. In fact, the data would suggest it may have decreased, further strengthening her conclusion that on average, educational borrowing is as sound an investment today as it has been in the past, and not just for dentistry. From time to time we hear that some dental hygiene graduates are struggling to find employment, but that appears to be a localized phenomenon. The Bureau of Labor Statistics reports that employment of dental hygienists is projected to grow 19% from 2014 to 2024, much faster than the average for all occupations, and U.S. News & World Report ranks dental hygiene number five on its 100 Best Jobs list.

At this point, I’m guessing there may be skeptics among you who remain unconvinced. You might be asking: Even if today’s average monthly student loan payment represents the same portion of income as it did 20 years ago, what about the fact that borrowers are taking almost twice as many years to pay off their debt? Doesn’t that constitute an increased burden?

Mert Aksu, D.D.S., J.D., M.H.S.A., Dean of the University of Detroit Mercy School of Dentistry, raised this very point with me and others after hearing Beth speak in October. Mert is concerned that dentists who are still paying off their loans will find it harder to fund their retirements, and he is particularly concerned about how this possibility might affect those who choose employment over owning their own practices. Historically, Mert pointed out, the dental practice itself has constituted the largest asset a dentist possessed at the time of retirement.

The Brookings study does not address the issue of retirement savings, but Beth told me the longer repayment period is not a cause for concern when looked at in strictly financial terms. From this perspective, lifetime earnings still outweigh the cost of student borrowing today just as they did in the past.

All that said, there may be less tangible costs associated with increased student indebtedness. One recent study using 1997 data found a small but significant inverse relationship between student debt and psychological well-being. In a posting on the Brookings website, Beth acknowledges that “It may be the case that debt imposes emotional costs,” but tempers that scenario by adding, “the treatment of student debt by the popular media has almost certainly caused some borrowers to worry about their debts more than they would have otherwise.”

In Mert’s view, changes in the market for dental care should also be factored in when considering the potential burden of indebtedness on our current and future graduates. He rightly points out that much of the growth in the dental market is occurring in Medicaid and other less well-reimbursed sectors. Mert speculates that, over time, this trend could depress those lifetime earnings the Brookings study is banking on.

Much of the discussion within our community about the growth of dental student indebtedness has centered on a related concern: whether high levels of educational debt might discourage newly minted dentists from providing care in underserved communities. To get a perspective from the practice community on this and other issues, I called Marko Vujicic, Ph.D., Chief Economist and Vice President of the American Dental Association (ADA) Health Policy Institute. Marko is one of the authors of the JADA paper I mentioned above, which looked at the effect of educational debt on dentists’ career choices.

According to Marko and his colleagues, their research indicates that high debt levels do influence some career decisions, but that gender and race are much better predictors of where dentists choose to practice and whether they choose to treat Medicaid patients or provide charity care.

“To the extent that you accept our results,” Marko told me, “you should explore interventions outside of debt relief if you want to influence career choice.”

Marko’s comments raise the question of whether current policy proposals aimed at lowering student debt levels are well designed to achieve larger societal goals. Beth is concerned that some proposed policies would benefit those who are most able to meet their debt obligations and do little for those who truly need help.

“Policymakers need to recognize that debt is not a bad thing,” she argues. “Debt without a means to pay is the thing that we need to be worried about.”

Beth points out that policies such as student loan refinancing at lower interest rates would disproportionately benefit people with large outstanding debt—the very people, research shows, who tend to earn high incomes.

“Things like income-driven repayment plans, which we’ve seen expanded in the last two years, are really a step in the right direction,” Beth believes. “These plans ensure that those who have made investments in higher education that didn’t pay off won’t be stuck with unaffordable monthly debt payments.”

Marko also warns that poorly conceived policies can create as many problems as they solve. He told me some economists oppose providing student debt relief because it takes the onus off schools to address rising tuitions. Likewise, in economic terms, the availability of federally subsidized student loans artificially lowers the cost of preparing for a professional career, potentially stifling the development of innovations that would reduce the cost of higher education.

“It comes back to what you’re trying to achieve,” Marko said. “Broad-brush policies can reduce the cost of education for everyone in America, but if we want to achieve different societal objectives, such as getting dentists to practice in underserved areas, a more targeted set of loan forgiveness policies would be more effective in achieving this end.”

When I asked Marko if the dental education data conform to Beth’s assessment that increased student debt reflects a largely positive development—increased investment in higher education—he responded, “Absolutely. Look, your dental education is an investment, and it’s a privilege to have an earnings stream as a dentist. You have to look at these questions in that context.”

I couldn’t agree more.

Related content from previous issues of Charting Progress
August 2014, A Dental Education Remains an Attractive Investment
September 2013, Getting a Handle on Educational Costs and Borrowing
February 2012, Student Debt: Cause or Symptom of Current Ills?
December 2009, Dental Hygiene Program Capacity: Finding the Right Balance
September 2006, Paying the Price