Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic shares news of a joint effort with the American Dental Association to change how dental professionals are assessed for licensure.

If you’ve ever talked with your colleagues about the clinical exams used for dental and dental hygiene licensure, you’ve heard this familiar litany of complaints: They are costly for students, often unfair to patients and fraught with potential for ethical compromise.

We’ve been hearing these grumblings for decades, but by and large, we’ve resigned ourselves to the idea that the way things are is the way they will remain. I’m happy to report that this grudging acceptance is giving way to new optimism. Change is visible on the horizon. Getting there is just a matter of time.

During the past 10 years, a few pioneering states have experimented with alternative ways to assess clinical competency for initial licensure—mandatory postgraduate training, portfolios, curriculum integrated format (CIF) exams and objective structured clinical exams (OSCEs). Most recently, Colorado opted to accept all of these alternatives as well as all of the traditional state and regional exams as pathways to licensure for both dentists and dental hygienists.

Colorado’s decision may be a bellwether of a nationwide shift away from the status quo and a major step toward license portability.

“It’s been a problem for dentistry for some time that state laws vary so much,” says Karen Hart, Director of the Council on Dental Education and Licensure at the American Dental Association (ADA). “When new and mid-career dentists want to move from one state to another, often they are required to retake the licensure exam, which includes demonstrating their skill on a patient. That’s burdensome, and according to available, albeit limited, published psychometric analyses of current patient-based licensure examinations, patient-based exams do not consistently and reliably determine an individual’s competency.”

ADEA went on record in 2011 opposing the use of live patients in licensure exams, and the ADA has held a similar position since 2005. With the increased migration of dentists across state lines in recent years, licensing reform became a top ADA priority, prompting that organization to invite ADEA to form the ADA/ADEA Joint Licensure Task Force—a recent development that should finally give isolated state-level experiments the fuel they need to scale up to a national level.

The Joint Task Force held its first meeting a year ago in August, and this February released a report with five recommendations:

  • Increase awareness and understanding of emerging licensure models.
  • Promote further development and piloting of alternative licensure models.
  • Increase understanding of the accreditation process.
  • Promote research and distribution of findings from alternative licensure models.
  • Publicly recognize and collaborate with others engaged in alternative licensure models.

ADEA and the ADA haven’t always seen eye-to-eye on every issue, but both organizations have fully endorsed the Joint Task Force recommendations. Even more importantly, both organizations have committed to concrete action to move the Joint Task Force recommendations forward. The ADA has established a steering committee to oversee the development of a Dental Licensure OSCE (DLOSCE), similar to the one currently used to license dentists in Canada and Minnesota. In parallel, ADEA will develop a template for a portfolio licensure exam along the lines of the one developed in California. These activities will advance our goal of creating valid and reliable assessments that states can use to test for clinical competency without involving patients. Over time, these alternatives might expand to include the use of manikins or haptics as the technology and economics of virtual testing evolve.

ADEA Immediate Past Chair of the Board Cecile Feldman, D.M.D., M.B.A., Dean of Rutgers, The State University of New Jersey, School of Dental Medicine, championed the idea of ADEA and the ADA coming together on common ground to improve the way U.S. dentists are licensed for practice. She serves on the Joint Task Force as Co-Chair and is the first to agree with my assessment that change is on the horizon, but she also points out that a long road lies ahead.

“The partnership between the ADA and ADEA was a natural,” she told me as we reflected on what has been achieved so far. “If you think of the licensing process as a three-legged stool, the testing and licensure folks are the other major piece of this. Whether they’re going to make some of the changes we feel strongly about remains to be seen.”

Indeed, at an April meeting of the American Association of Dental Boards, it quickly became clear that the ADA’s proposed DLOSCE remains controversial among the very dental boards that might ultimately be called upon to recognize it.

“The DLOSCE will take two to three years to develop,” Karen estimates, “and then we will have to advocate state-by-state for its adoption. In the meantime, we will work with state dental boards, state dental associations and dental schools on license portability so that all of the clinical licensure exams can be accepted by each state.”

Reaching these goals will require continued patience but also a sense of urgency. Our efforts are occurring at a time of heightened federal interest in occupational licensing. There has been a lot of discussion about just how much certification and licensure is really needed to protect the public, with the Federal Trade Commission devoting considerable energy to address this concern. In July, the agency’s Economic Liberty Task Force held its first public roundtable on the matter.

Given these pressures, I’m heartened by the strong partnership ADEA has formed with the ADA and the rapid progress we’ve made in a single year. As we move forward on achieving universal acceptance of a nonpatient-based licensure exam, we are inviting the American Student Dental Association to join us under the umbrella of a newly established Coalition for Reform in Dental Licensure.

Those of us who have been tackling this problem for decades know that it will take some time to convince everyone that change is not just possible, but in everyone’s best interest, including the public’s. There is a growing recognition that the issues dental boards handle on a routine basis have little to do with the dentists entering the profession and a lot to do with the behavior of dentists already in practice. Whether fraud, substance abuse, inappropriate prescribing or failure to meet standards of care, misconduct can arise at any point in a decades-long career. If licensure becomes more standardized, could more board resources be spent on curbing these behaviors? Maybe.

ADEA is planning to review the complaints that dental boards address to identify specifically which disciplinary actions occur most frequently in all 50 states and the District of Columbia. This research may reveal whether new dentists who gain licensure through alternative means are any more likely to be censured than their peers in states that use patient-based exams. If the answer is no, it will become harder to justify using patient-based exams or not letting licensed dentists and dental hygienists practice across state lines.

As Cecile has said, “The boards’ perception that these clinical exams are effective in preventing unqualified practitioners from entering practice—the two just aren’t related.” For those who disagree, this coming research should shed additional light on the matter and hasten the day when alternatives to live-patient licensure exams are implemented across the nation.

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic shares news of the movement to build resilience among health professionals.

The statistics are alarming. So many physicians commit suicide that in any given year it could take up to four medical school classes of 100 graduates to replace them. No one tracks the number of physicians in training who end their own lives, but a systematic review and meta-analysis published last December in JAMA, the Journal of the American Medical Association reported that 11% of medical students consider taking this action.

Compared with the general public, physicians are roughly twice as likely to commit suicide, and for decades we’ve assumed that dentists were also at higher risk, even though studies in the 1970s and ‘80s found no evidence to support that assumption. Does that mean our profession doesn’t have a problem? Hardly. It simply means our profession lacks definitive data about what is truly happening with students, residents, fellows and practitioners when it comes to burnout, depression and suicide.

What we have studied is dental student stress—undoubtedly a precursor to these other phenomena. In 2014, researchers at McGill University Faculty of Dentistry conducted a systematic review of the literature on stress in dental students. The researchers found that considerable amounts of stress emanate from the demanding nature of dental education, specifically examinations, grades and workload. Interestingly, dental students reported higher levels of stress than their medical school counterparts—reason enough for ADEA to give serious consideration to how we can promote wellness, well-being and resilience among faculty and students.

Definitions of wellness vary and can be extensive, but for simplicity’s sake, the Merriam-Webster dictionary defines it as “the quality or state of being in good health.” Wellness is also a component of well-being, which comprises not just physical health, but (depending on which definition you use) social, psychological, financial, spiritual, career and other dimensions of health. Resilience is defined as “an ability to recover from or adjust easily to misfortune or change.”

We used the ADEA Joint Council Administrative Boards (ADEA JCAB) annual business meeting at the ADEA offices in Washington, DC, earlier this year to begin discussing how we might foster these qualities in our members. ADEA Chief Policy Officer Denice Stewart, D.D.S., M.H.S.A., organized that meeting, and she will also be presenting on becoming a resilient leader at the 2017 ADEA Sections on Business and Financial Administration and Clinic Administration (ADEA BFACA) Meeting this coming October.

But this is not just a top-down initiative. Wellness, well-being and resilience have also been on the minds of ADEA Council of Faculties members over the past year. Inspired by what they learned at the ADEA JCAB meeting, some of these individuals decided to take action. As a first step, they developed a common understanding of what these concepts are all about and used a portion of their ADEA Annual Session & Exhibition business meeting to share what the literature says on wellness, well-being and resilience with the rest of their Council.

“We wanted people to leave with long-term, short-term and in-the-moment strategies they could employ immediately,” says Sophia Saeed, D.M.D., Associate Professor of Preventive and Restorative Sciences at the University of California, San Francisco, School of Dentistry (UCSF SOD). Sophia took the lead in developing the training. “We wondered,” she told me, “could we take small steps in our own behaviors, in the way we react to certain situations, so that we are better to ourselves and better role models for our students?”

Forty people attended the session and found it useful, as did a smaller group at UCSF SOD, so the Council is now partnering with the ADEA Council of Deans and the ADEA Council of Students, Residents and Fellows to develop new programming with a broader goal.

“This will be more of a dialogue,” Sophia told me. “Depression, burnout, suicide—these things are still stigmatized topics. Our goal for the Annual Session meeting will be to hear about these issues from the perspectives of the students, the faculty and the administrators and to ask, ‘How can we all work together to solve this problem?’”

Sophia believes that everyone, not just those in formal leadership positions, can make a contribution. “The way you behave has an impact on everybody around you. We know that from science,” she says. “A grassroots movement where everyone made a commitment to being kinder to each other, that could really have a huge impact on educational and health care institutions.”

That’s a compelling vision, and individuals who embrace it should find considerable institutional support. In the last year alone, major entities have publicly expressed their concern that stress among health professionals is taking too great a toll on providers and putting the quality of care at risk.

  • The National Academy of Medicine has convened the Action Collaborative on Clinician Well-Being and Resilience to study the problem. Last month, the ADEA Board of Directors approved ADEA’s participation as a sponsoring member. As part of this initiative, I was privileged to be part of an interprofessional group that authored a discussion paper laying out a systems approach to addressing these issues in both education and practice.
  • The Accreditation Council for Graduate Medical Education has begun studying deaths among residents to gain insight into the phenomenon and how it might be prevented.
  • Our sister organization, the Association of American Medical Colleges, convened a meeting to address burnout, depression and suicide among physicians.
  • More than 62,000 people signed a petition calling on medical associations to address the “culture of abuse” that contributes to these problems.
  • The CEOs of 10 health care delivery organizations held a summit, which concluded, “[P]hysician burnout is a pressing issue of national importance for patients and the health care delivery system.” They urged their peers to “embrace physician well-being as a critical factor in the long-term clinical and financial success of our organizations.”

These efforts build on earlier work, including an effort by the American Dental Association (ADA) to help practicing dentists build resilience. In the spring issue of the ADEA CCI Liaison Ledger, ADA Executive Director and Chief Operating Officer, Kathleen O’Loughlin, D.M.D., describes her own commitment to fostering wellness among practicing dentists and its relevance for dental students and faculty members. (Two other articles describe related work by our colleagues at the Dental College of Georgia at Augusta University and at the University of Kentucky College of Dentistry.)

I hope by now most of you have heard of the IHI Triple Aim initiative, a framework developed by the Institute for Healthcare Improvement. The framework’s three goals—better patient care, improved population health, and reduced health care costs—have been a beacon for health systems that want to do better. Since 2014, we’ve heard calls for adding a fourth aim: improving the work life of health care providers to address burnout and restore feelings of joy and satisfaction in work. Those calls are growing louder by the day.

It is possible to live with stress and find professional fulfillment, as Kathy’s essay beautifully articulates, but for most people, finding that balance is a challenge. This reality became painfully evident for many in our community with the passing of Jiwon Lee, a predoctoral student at Columbia University College of Dental Medicine who was known to many through her role as President of the American Student Dental Association. And each of us has suffered the loss of other less-familiar individuals as well. I am heartened that our community—and the health professions generally—are now focused on averting future tragedies and restoring balance to the lives of students, residents, fellows, faculty and practitioners. These steps are essential—not just to each individual’s personal health, but to the long-term health of our professions and ultimately, our patients.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic describes a new ADEA initiative that takes the long view—engaging today’s students to eventually fill the faculty pipeline.

In 2016, the ADEA Board of Directors approved an initiative to encourage and expand the establishment of ADEA Chapters for Students, Residents and Fellows. At last count, 30 U.S. dental schools had chapters, and eight more schools had plans to create one. Most chapters are quite young, with the majority established in the last five years. As of yet, there are no formal chapters in Canada, but ADEA has set a goal of establishing a chapter at every North American dental school, and the ADEA Council of Deans has created a working group to help ensure that this happens.

What do we hope these chapters will accomplish? Their primary purpose is to promote student interest in academic careers, or as one chapter founder put it, become “the group at every dental school that tells the story of how great a career in academic dentistry is and how accessible that career can be for anyone who wants to pursue it.” That is the vision of Tim Treat, D.D.S., who started an ADEA chapter at the Indiana University School of Dentistry (IUSD) in 2014.

Tim graduated last year and currently serves as the ADEA Board Director for Students, Residents and Fellows. He likes to tell the story of what started him down the path toward academic dentistry. In 2013, the IUSD Dean of Students reached out to the school’s class presidents to see if any were interested in attending the ADEA Annual Session & Exhibition. Unlike his peers, Tim said, “Yes.”

“So I’m this first-year dental student, on my own, flying to Seattle, and a couple days later I’m at the ADEA Gies Awards sitting next to the Dean of the dental school and seeing the celebration of amazing things people were doing all over the country to make dental education better,” he recalls. That interaction with faculty and administrators in that environment hooked Tim on the idea of an academic career, and his exposure to the ADEA Council of Students, Residents and Fellows (ADEA COSRF) helped him see how an ADEA chapter might help make that possible. He returned to Indiana, enlisted the support of classmate Mackenzie Kelley, and together they worked to create an ADEA student chapter at IUSD.

Today, that chapter is going strong. It hosts the school’s annual Dental Day for prospective students, and its Last Lecture series, where retiring faculty members tell their stories, is among the best-attended events at the dental school.

“Tim has really been able to bring ADEA to life for our students,” says John Williams, D.M.D., M.B.A., the Dean at IUSD. “The students have now gone on to become involved in additional aspects of ADEA. In fact, the current COSRF chair is an Indiana third-year student, Allison Williams.”

IUSD faculty and administrators also report that students have begun approaching them to learn about academic careers since the school formed its chapter two years ago. Tim is not surprised. During his tenure as an ADEA Board Director, Tim has learned about the great need for dental educators in the face of pending retirements. He sees this as an opportunity for his generation to “get into faculty positions and make a difference,” and he believes the timing couldn’t be better.

“More and more students each year will never own their own practices. Academic dentistry is an alternative with many benefits,” Tim says. He is clearly convinced of that. He is currently in a general practice residency at the Veterans Administration hospital in Indianapolis. Once completed, he intends to return to his alma mater to teach, and thanks to John Williams, a wonderful new transitional appointment awaits him.

“A year ago I created a clinical fellowship program for prospective faculty who had recently graduated,” John told me. The two-year fellowship will allow students who have completed a general practice residency or AEGD program to continue to develop their clinical skills and an academic portfolio. They’ll learn about teaching, assessment, curriculum management, accreditation—even the finances of dental education. “It will be a robust exposure to what it means to be an academic,” John says.

Recent events at IUSD represent exactly the types of developments we need in order to ensure that the next generation is ready to step into our shoes. It is estimated that only 4% of students need to go into academia to solve the future faculty problem. In other words, if two or three graduates from each dental school were to follow Tim’s path, those projected faculty vacancies that keep us up at night would disappear. The first step is to make sure that students know about ADEA and are aware that academic careers are an option.

“Every academic institution has an opportunity, if not a responsibility, to engage their students in this option,” John believes. “The more we can talk to students early on and get them good role models, the more I think you’ll have a significant improvement in faculty recruitment and retention.”

One of those role models is Jennifer Perkins, D.D.S., M.D., Assistant Professor in the Department of Oral and Maxillofacial Surgery at the University of California, San Francisco, School of Dentistry (UCSF SOD). She is also the winner of this year’s ADEA/ADEA Council of Students, Residents and Fellows/Colgate-Palmolive Co. Junior Faculty Award.

Jennifer is nothing if not approachable. She remembers that as a resident, she was always the one that people would come to with questions. As one of the newer full-time faculty members at UCSF SOD, she’s developed a similar reputation.

“It didn’t take very long after my getting here in 2014 for word to get out that I was someone students could come to,” she says. Today, Jennifer’s reputation as an oral surgeon, academic, parent of four, and go-to person for advice on dental career decision-making even draws occasional calls from students on other campuses.

“I’m not a guru who knows the answers to everything,” she says, “but you know, being willing to put time in with students, that makes an impression.”

Many faculty take the time to mentor students, but junior faculty, perhaps by virtue of their relative youth, tend to be especially effective role models. Jennifer had a mentor of her own who provided the support and reassurance that she would be a good candidate for oral surgery. Her decision to pursue an academic career came later.

“I didn’t know that was going to be my career necessarily until another faculty member here in my training program told me on multiple occasions—just out of nowhere—‘You’re really meant to do academics and be a teacher.’”

When she did start teaching part time, she says it became “obvious” to her as well that she needed to become an educator. “I get equally, or more, excited about teaching as about all the other parts of my job. So I think if I was in private practice, I would really be missing out on one of the things that kind of gives life to my career: getting to interact with the next generation.”

The students in UCSF SOD’s ADEA Student Chapter nominated Jennifer for the ADEA Junior Faculty Award. ADEA at UCSF SOD is one of the largest and most active ADEA chapters. In existence for more than 10 years, it hosts outreach events for high school and college students, two lunch and learn series and tutorial sessions for dental students, and faculty/student mentorship programs—one for first-year students, and another through the ADEA Academic Dental Careers Fellowship Program (ADEA ADCFP). Not surprisingly, UCSF SOD has now received an ADEA Distinguished Chapter Award five years in a row!

This month, ADEA will unveil the ADEA Chapter Toolkit for Students, Residents and Fellows at the first-ever ADEA COSRF Leadership Orientation to be held here in Washington, DC. The toolkit is a dynamic resource intended to help ADEA Student Chapters cultivate interest in academic dental careers. It includes information and resources to guide chapter creation, member recruitment, fundraising and planning events that will raise awareness of academic dental careers.

“It’s a matter of putting this on the radar screen and letting students make their own decisions,” John Williams believes, “but it’s far easier to do it when you have a strong ADEA Student Chapter and people know why it’s there.”

I couldn’t agree more.

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic reviews the abundance of diverse programming—and programming related to diversity and inclusion—at the 2017 ADEA Annual Session & Exhibition in Long Beach, CA.

Last month saw another ADEA Annual Session & Exhibition come and go, and while I’m always impressed by what each ADEA Annual Session Program Committee (ADEA ASPC) can pull off, this year’s meeting was exceptional. The waterside venue in Long Beach, the California sun, and—most importantly—the programming, were all superb, and the presence of a record-breaking number of members made the atmosphere electric.

Blasting Off!

Many attendees joined us for the first time, and with over 400 separate events to choose from, I’m sure the process of getting oriented was daunting for some of our new participants! Fortunately, ADEA member Nisha Ganesh from East Carolina University organized an event to help first-time attendees navigate the meeting. Saturday’s first-ever Find Your Tribe session offered 100 newcomers lunch, icebreaker activities and the support of an “Army of Connectors.” These conference veterans, including most members of the ADEA ASPC, answered questions and brought people with similar interests together.

This year’s theme was Beyond Boundaries, and the Opening Plenary with physician/astronaut Mae Jemison set the stage for sessions designed to take us out of our comfort zones and into less familiar territory. She inspired us with her quest to support interstellar travel and her conviction that humankind can progress in striving for such goals. Her jokes about Star Trek (she once made a cameo appearance on the show) also pleased many in the audience who were clearly fans—then-Chair of the ADEA Board of Directors Cecile Feldman among them. Who knew that Cecile once dreamed of going into space?

I should also note two other highlights of this particular plenary. First, there was hardly a dry eye in the house when Cecile bestowed this year’s Distinguished Service Award on ADEA Senior Scholar in Residence Leo Rouse, D.D.S., who has served as a mentor to hundreds, if not thousands, during his career. I was also personally touched by her surprise acknowledgment of my 20 years of service as ADEA CEO. Hard to believe it has been that long. The time has really flown!

Politics as [Un]usual

This year’s Political Spotlight was also a big hit, and provocative from the word go. As luck would have it, the House of Representatives was just starting its hearings on President Trump’s wiretapping allegations as the session began, so the discussion couldn’t have been more timely.

Well-known political commentators Ana Navarro and Hilary Rosen entertained attendees with their pointed comments on the flurry of activity that has been roiling the federal government these past few months. To judge from the informal conversations occurring throughout the convention center and beyond, the uncertainty in Washington is creating a lot of anxiety for all of us. Despite their wide range of political views, our members (and the country as a whole) are used to a certain tempo and restraint in the nation’s political discourse. Both have been absent of late, leaving everyone feeling unsettled.

“The scope of federal decisions that could affect us—everything from Medicaid to GME to HRSA to CDC to accreditation to student loan programs—it goes on and on and on,” Cecile recently remarked. “The only thing that’s predictable right now is that the unpredictable will occur.”

One silver lining amid the turmoil may be a boost in member engagement. ADEA’s Chief Advocacy Officer, Yvonne Knight, told me that in Long Beach, she heard more members express appreciation for ADEA’s advocacy work than ever before. I urge those of you who want to join our work here in Washington to participate in our ADEA Virtual Hill Day on April 26.

Diversity and Inclusion

Like many of our previous plenary speakers, Jemison, Navarro and Rosen had star power. No doubt about it. But arguably, the brightest light at this year’s Annual Session was supplied by Anne Koch, D.M.D.—an endodontist, entrepreneur and faculty colleague of mine from our time together at the Harvard School of Dental Medicine—who spoke about the needs of transgender patients and her own experience transitioning. She addressed a packed audience at a morning seminar that officially ended at noon but unofficially continued until almost 3:00 p.m. while Anne answered questions and talked one-on-one with attendees. A few hours later, she headlined our new Sunday evening plenary, “In the Mix” Series: Inclusion, Excellence and Dental Education—a time for members to actively network with one another while exploring the many faces of diversity and inclusion.

I don’t remember the last time we had a dental educator as a plenary speaker, but having one of our own speak to these particular issues was extremely powerful. If you’ve already met Anne, you know she has an open and engaging personality. She’s also a dynamic presenter. You could hear a pin drop during her remarks, and when the discussion portion of the plenary began, everyone participated. Without a doubt, this new event on diversity and inclusion was a huge hit and highlight of Annual Session for many. Anne’s assessment? She told me, “I felt like I belonged at this meeting for the first time!”

It’s interesting to note that, although unintentional, all of this year’s plenary speakers, including the Google executive who provided pointers on innovation Tuesday morning, were women, and a racially and ethnically diverse group at that. Yet, no one seemed to notice—which says a lot about our community and about ADEA’s success in promoting diversity and inclusion at this meeting and beyond.

Although much of the programming reflected the theme of this year’s meeting, Beyond Boundaries, diversity and inclusion sessions were woven throughout the fabric of the event. Their importance was affirmed again and again—starting with a two-day preconference workshop for participants in the ADEA/W.K. Kellogg Foundation Minority Dental Faculty Development and Inclusion (MDFDI) Program, featuring former Health and Human Services Secretary Louis Sullivan, M.D., and ending with voting on resolutions at the closing of the ADEA House of Delegates.

Building a diverse oral health team is one of the four themes Dr. Leon Assael, the new Chair of the ADEA Board of Directors, plans to emphasize during his year as Chair. “Diversity is the critical issue that will affect the oral health professions in the coming decade,” he told the delegates. “If our students reflect the communities they serve, if they feel comfortable caring for patients who reflect all facets of the human experience, we will see palpable improvement in American society.”

The diverse range of attendees also made this a year a standout.

  • Our effort to draw more Canadian members to the meeting was a big success, and we were able to move forward with the discussions we began in Montréal related to AADSAS® and ADEA’s survey work.
  • Several of our European colleagues were also in attendance, including the President, President-Elect and Director of the Association of Dental Educators in Europe (ADEE), whom we’ll be seeing again at our joint meeting in London next month.
  • More than 600 students and a few parents and health professions advisors attended this year’s ADEA GoDental Recruitment Event. They met with representatives from 47 dental schools and 11 organizations, including three branches of the U.S. Armed Services, participating for the first time.

Looking Ahead

When the world appears to be chaotic, it’s easy to be discouraged, but to judge from the ADEA members in Long Beach, dental educators are excited about the opportunity to face the future. They believe, as do I, that we have the resources and the talent to take on the challenges before us.

What are those challenges and opportunities? Three Chair of the Board symposia and a fourth session on the future of allied dental education answered this question, each in its own way. A presentation by Kaiser Permanente’s Nirav Shah, M.D., M.P.H., on health care transformation had a lot people talking, as did two presentations on the future of dental education in the 21st century. Some of the views expressed were highly controversial, but the opportunity to engage in stimulating debate was well received.

A series of short TED Talks-style presentations on educational innovation and the unveiling of a newly reconstituted ADEA Commission on Change and Innovation in Dental Education (ADEA CCI) 2.0 also contributed to the mix of programming. I heard a lot of praise for these sessions, which challenged ADEA members to rethink their assumptions and join the ongoing effort to shape the future of dental education. Especially in the area of licensure, a topic I’ll be covering later this year, attendees welcomed the opportunity for dialogue.

All in all, the depth and scope of this year’s programming was exceptional, reflecting the elevated level of engagement within ADEA sections and councils, the membership’s willingness to freely share ideas and resources, and the generosity of our Corporate Members. As ADEA’s Chief Policy Officer, Denice Stewart, D.D.S., M.H.S.A., remarked when we spoke last week, those who say that face-to-face meetings will go away in the era of global communications are missing something fundamental. The opportunity to meet and mix with colleagues from all over the world adds what she called “an extra layer of richness,” and reinforces the sense that we are all pursuing a common goal.

That sense is all the more palpable when the opportunities for interaction are diverse and the attendees bring an array of backgrounds and experiences. I have no doubt these qualities will be on display when we meet next March in Orlando. Please consider submitting a program, poster or TechExpo presentation for the 2018 ADEA Annual Session & Exhibition, Vision 2030, and help us continue to shape the future of dental education.

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic describes a renewed ADEA initiative to strengthen the Association’s relationship with its Canadian members.

It’s no secret that ADEA aspires to play a greater role on the global stage. In 1992, we cofounded the International Federation of Dental Education Associations (IFDEA). In 2007, our Association met with colleagues from 66 nations at an IFDEA summit in Ireland, and IFDEA was subsequently reborn as the International Federation of Dental Educators and Associations. We’ve hosted five ADEA International Women’s Leadership Conferences in France, Canada, Sweden, Brazil and Spain. This April, the ADEA Board of Directors will be leading an oral health delegation to Cuba, and, in May, ADEA and the Association for Dental Education in Europe will be offering their members a two-day collaborative meeting in London. (I’ll be reporting on both events this summer.)

But closer to home, we have also come to realize there is more we can do to forge closer ties with those ADEA members who live north of the U.S.-Canada border—and there are many reasons for engaging them more fully in ADEA’s work and us in theirs.

Monty MacNeil, D.D.S., M.Dent.Sc., Dean of the University of Connecticut School of Dental Medicine and ADEA Board Director for Deans, recently shared these thoughts with me: “Subtle differences can be powerful tools for learning from each other. It’s important to look at how we do things—how we are alike and how we differ and what we can borrow from each other to create the most effective strategies for advancing dental education.”

Monty should know. He has spent half his life in the United States and half in Canada. When the Dalhousie University Faculty of Dentistry graduate came to the States for advanced dental education in the 1980s, he was struck by the fact that some U.S.-based dental schools had not yet adopted the competency-based teaching and assessment approaches he was familiar with at home. On the other hand, he discovered a robust and captivating research environment that ultimately led him to pursue a career in the United States.

Finding adequate research dollars is a challenge most everywhere, but U.S. dental educators are relatively fortunate in this regard compared with our Canadian counterparts. (For more on the ways our Canadian colleagues are bolstering their research enterprise, see my earlier post, Re-imagining Dental Education in Canada.) In addition to federal and private dollars that support academic research, U.S. dental educators benefit from ADEA’s in-house research arm, which generates data about our educational endeavors.

Dan Haas, D.D.S., B.Sc.D., Ph.D., Dean of the University of Toronto Faculty of Dentistry (U of T FOD), is eager to tap into that ability. “In Canada, we have not had the capacity to do national exit surveys of our graduates or even incoming surveys to get a snapshot of who our students are,” Dan told me. He would like access to ADEA’s expertise to form a national picture of how Canadian students are doing, where they are going professionally and whether Canada’s predoctoral education programs are achieving their goals. He’s also interested in learning more about the faculty experience—all achievable goals if ADEA expanded its surveys to include Canadian schools.

This possibility was one of several topics raised during a Montréal meeting last November with Dr. Monty MacNeil, several senior members of the ADEA staff, the deans or associate deans of nine of the 10 Canadian dental schools, and representatives of the Association of Canadian Faculties of Dentistry (ACFD), ADEA’s sister association in Canada.

Canadian schools first joined the ADEA fold decades ago, but their priorities and challenges remain uniquely Canadian. A desire to bridge that divide to better engage and serve our Canadian members inspired Monty and ADEA’s Senior Scholar in Residence, Leo Rouse, D.D.S., to propose the November meeting. Including Canadian schools in ADEA’s surveys was just one of several ideas floated by the meeting participants. We also discussed bringing Canadian schools into ADEA AADSAS® (ADEA Associated American Dental Schools Application Service) for predoctoral students.

Currently, only the University of Dalhousie Faculty of Dentistry participates in ADEA AADSAS. Including all Canadian dental schools would require making the application available in French for French-speaking students applying to the three dental schools in Québec. We are already exploring this possibility with Liaison International, our application services partner.

Paul Allison, B.D.S., Ph.D., Dean of McGill University Faculty of Dentistry and President of ACFD, is also enthusiastic about Canadian schools working more closely with ADEA. In addition to having Canadian dental schools participate in ADEA surveys and ADEA AADSAS, Paul would like to find ways to engage more Canadian faculty in ADEA’s professional development programming.

“There are some fantastic opportunities for learning and networking at these big ADEA meetings,” Paul told me, but he says making Canadian participation a reality can be challenging. “Speaking for McGill, when we send someone away to a conference in the middle of the academic year, it affects the teaching. We just don’t have the spare capacity.”

Funding can also be an issue for small schools with tight budgets. This year, ADEA took steps to ensure that all Canadian faculty were aware of our policy that any dental faculty member who had not previously attended an ADEA Annual Session could apply for free registration for the 2017 ADEA Annual Session & Exhibition.

“We have three new hires who started in July,” Dan told me, “and all three jumped on this because they want to learn how to teach, so I was quite thrilled.” This will be U of T FOD’s largest turnout at any annual meeting in memory, in part because Dan is also supporting the attendance of several of his academic administrators. Paul also mentioned that a number of Canadian deans will be attending this year.

As the current President of the ACFD, Paul sees other ways that ADEA could help Canadian schools over the long term. ACFD provides a forum where Canadians can network and help one another on issues that pertain to dental education in Canada. The association also represents the Canadian dental education community in interactions with other organizations that influence Canadian dentistry. Nevertheless, in comparison with ADEA, ACFD is small and more limited in what it can do. Paul hopes that closer ties between the two organizations will eventually lead to a greater range of services for ACFD members while freeing up ACFD to focus exclusively on Canadian concerns.

And how would this “rapprochement” benefit ADEA members here in the United States? Our Canadian colleagues recently published a new predoctoral competency document, and they have just agreed to create a working group to explore various postgraduate education models with the idea of establishing a mandatory postgraduate year for new dentists. If history is any guide, these efforts will provide inspiration and models that also inform the evolution of dental education in the United States.

“Collaboration is how you grow,” Dan says, “not in size but in continuing to get better at our two main missions: research and education.” I heartily agree with that statement, and believe cross-border collaboration is a potent facilitator of that growth.

“At the end of the day,” Monty points out, “we do the same things. We educate students, we provide care to patients and especially the underserved, and we have a research mission within our universities that can be quite substantial. It’s just a matter of defining where we can help each other achieve the best results.”

In many ways, U.S. and Canadian dental education are already intertwined. Each year, 150 Canadians cross the border to study dentistry in the United States. The two systems have reciprocity in terms of accreditation, and three U.S. dental schools now have Canadian-born deans.

Just as importantly, the cross-border sharing of ideas plays a substantial role in advancing educational policy and practice in both nations. Consider, for example, these two practices—Objective Structured Clinical Examination, a Canadian export that has gained traction in the United States, and holistic review, which has crossed the border in the opposite direction—and the value of this international collaboration immediately becomes clear. ADEA is taking concrete steps to advance this collaboration, including sending a delegation to the ACFD annual meeting in Québec City in June. I have no doubt these and other efforts across North America will serve all ADEA members well in the years ahead.

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic reflects on his own experiences as a student and looks at the ways three different schools are encouraging a new generation to engage in research.

A slight diversion: While I have you and before I address the topic of this month’s letter, I want to call your attention to exciting changes with the ADEA Commission on Change and Innovation in Dental Education (ADEA CCI). In 2016, the ADEA Board of Directors determined there had been immense success as a result of the Commission’s work since 2005, and it was the appropriate time to renew ADEA’s commitment to change and innovation in dental education. Therefore, I am pleased to inform you that ADEA CCI 2.0 is getting underway. I encourage you to read the guest editorial that Dr. Cecile Feldman, Chair of the ADEA Board of Directors, and I wrote explaining the idea behind ADEA CCI 2.0. The guest editorial will also appear in the March issue of the Journal of Dental Education.

On to this month’s letter: Last fall I was invited to speak about research and scholarship and their roles as engines of dentistry. The occasion was the Hinman Student Research Symposium, co-sponsored by the Atlanta-based Hinman Dental Society and the University of Tennessee Health Science Center College of Dentistry (UTHSC COD). The college has made promoting a robust research program part of its mission, and my visit there gave me the opportunity to reflect on the experiences that propelled me to pursue an academic career.

When I applied to dental school, I was planning to return to my hometown and become a successful general dentist. As you might guess, that’s not what happened. While at the University of Connecticut School of Dental Medicine, the school’s research requirement and my faculty mentors nudged me in a different direction. I found myself exploring Strep mutans, taking part in a table clinic program sponsored by SCADA (a joint venture between ADEA Corporate Member Dentsply Sirona and the American Dental Association), and eventually completing a pediatric dental residency at Children’s Hospital Medical Center in Boston. By the end of that experience, I was hooked on research and had set my sights on a career in dental education. I secured a position on the faculty at Harvard School of Dental Medicine, and I haven’t looked back.

Tim Hottel, D.D.S., M.S., M.B.A., Dean at UTHSC COD, also pursued research as both a predoctoral and graduate student, and appreciates the benefits of engaging in this pursuit early on. Since arriving in Memphis seven years ago, he has been encouraging both faculty and students at his institution to take the plunge.

“You never know when one of these young people will come onto something that changes the face of dentistry,” Tim told me. “But you have to introduce them to research if you want them to do it.”

Making that introduction comes fairly easily at UTHSC COD since the Hinman Student Research Symposium, now in its 23rd year, brings student researchers from dental schools across North America to Memphis every October. Tim’s success in engaging students in research also comes through another channel: the college’s faculty. Tim began encouraging them to develop projects when he first became dean, and along with Franklin Garcia-Godoy, D.D.S., M.S., Ph.D., his dean of research, has been successful in bringing in alumni dollars to support that effort. As a result, the college—while not a research-intensive dental school—now boasts more than 100 publications in peer-reviewed journals each year.

“This is what drives student interest,” Tim told me. “The faculty talk about their research with the students, and then the students get excited and away they go!”

Indeed, student research appears to be thriving on a number of dental school campuses that are relatively new to the research game. One of those schools is Roseman University College of Dental Medicine (Roseman CODM), founded in 1999. Perhaps best known for its mastery-learning pedagogy, this private, not-for-profit dental school is well on its way to developing a strong culture of scholarship and research. Roseman boasts an active cohort of student researchers, including a two-time winner of a prestigious SCADA student research award.

According to Roseman Dean Frank Licari, D.D.S., M.P.H., M.B.A., cultivating the next generation of dental researchers starts with the school’s holistic admissions process. Roseman has welcomed a number of candidates with Master’s and Ph.D. degrees (including the aforementioned award winner) who are interested in continuing their research while they are in dental school. “And in turn, those students serve as role models to some of our other students who have never done research,” Frank says.

All Roseman dental students have the option of taking part in research beginning in their first year. Those who show an interest are paired with faculty to get a better sense of what a research career would be like. In talking with Frank, it became clear that there’s a lot of one-on-one mentoring going on at Roseman.

“When you identify students who have that level of knowledge and ability and excitement and curiosity,” Frank says, “it’s important that we encourage them to look at academic and research careers.”

It is no secret that these can be a tough sell at many schools, but Frank says the Roseman faculty set a positive example. “Students see that people love to come here to work, that they want to be part of the college, so that encourages students to consider academic careers.”

Clark Stanford, D.D.S., Ph.D., Cert. Prosthodontics, Dean at the University of Illinois at Chicago College of Dentistry (UIC COD), is also eager to cultivate a cohort of budding scholars. Nine years ago, Luisa DiPietro, Ph.D., D.D.S., started UIC’s Multidisciplinary Oral Science Training (MOST) Program, which provides research-training opportunities for students along the higher education continuum. (The program is currently run by Anna Bedran Russo, D.D.S., Ph.D., along with Dr. Lyndon Cooper, D.D.S., Ph.D.)

A select group of UIC COD predoctoral students participate in MOST’s joint Ph.D./D.M.D. program. This predoctoral immersion in research takes “dedicated mentors and carefully selected students, and you have to work with them intensively,” Clark says of the seven-year, dual-degree program. It also takes money. Some financing comes from National Institutes of Health T32 training grants to the college and individual fellowship awards received by the students, and the College of Dentistry also contributes by waiving tuition for students who pursue the dual degree.

“We see the program as a strategic investment in the profession,” Clark told me. “We’ve also invested in physical renovations and in recruiting talented faculty, but the dual-degree program helps to change the culture in dentistry, to break down the wall of separation between research and clinical faculty. By having a cadre of junior scientists, we bridge that gap.”

One day, Clark’s “bridge builders,” and the student researchers at Roseman CODM, UTHSC COD and elsewhere will fill the faculty ranks and even shake the world with their discoveries, but they are already serving an important function. Their deeper appreciation of the value of scientific investigation to inform clinical practice is rubbing off on their peers. Everyone I spoke with agreed that all students need to understand scientific principles in order to make sound clinical decisions, and they believe exposure to research at the predoctoral level is crucial to achieving this goal.

Ultimately, patients benefit from these activities and so does the profession. Knowledge and technology are doubling every 12 to 15 years, and that rate will only accelerate as time moves forward. To remain a learned profession and retain the trust of those we serve, we must continue to investigate the dental and craniofacial complex, develop the evidence base for what we do, and make ongoing scholarly contributions that support human health.

We are fortunate as a profession. Our understanding of the oral cavity gives us an advantage in this endeavor. Not only is the mouth a mirror of the body, it is also easily accessible from a research perspective. By studying saliva and tissues in the mouth, dental researchers can shed light on cancer, pain, infectious diseases, glandular function, genetics, biomimetics and tissue engineering, not to mention oral health and well-being.

Cultivating the next generation of researchers may be relatively easy. Researchers are persistent, curious, motivated, focused, even aggressive. They possess a raw intelligence, a love of science, and a desire to improve the status quo. They find the balance between skepticism and receptivity. They are also hard working. As Thomas Edison famously said, “genius is 1% inspiration and 99% perspiration.”

Many of today’s predoctoral students possess these qualities in spades. We owe it to them—and to our profession—to nurture their interest in science and provide clear career paths that lead to scholarship and research.