Change Is Here: ADEA CCI 2.0-A Learning Community for the Advancement of Dental Education.

On May 12, 2005, the inaugural meeting of the American Dental Education Association Commission on Change and Innovation in Dental Education (ADEA CCI) was convened. Comprised of thought leaders representative of dental education and practice, the ADEA CCI published groundbreaking white papers that effectively helped bring dental education across the threshold of the 21st century. Twelve years later, a new ADEA CCI has been convened-ADEA CCI 2.0. The ADEA CCI 2.0 is a broad-ranging, strategically interconnected, flexible, and multifarious community of stakeholders situated within and across all facets of oral health education and practice. Whereas the first iteration of the ADEA CCI made the case for change regarding revisions of the dental curriculum and learning environment, the ADEA CCI 2.0 will focus on external domains that are having a global impact on the content and delivery of health care and health professions education and, ultimately, how health care benefits people. The principal work of the ADEA CCI 2.0 will be to create educational and implementation resources and opportunities for dental educators to contemplate, investigate, and ultimately define the future needs of their academic dental institutions in this constantly changing world.

An overview of case-based and problem-based learning methodologies for dental education.

Dental education has undergone significant curriculum reform in response to the 1995 Institute of Medicine report Dental Education at the Crossroads and the series of white papers from the American Dental Education Association Commission on Change and Innovation in Dental Education (ADEA CCI) first published in the Journal of Dental Education and subsequently collected in a volume titled Beyond the Crossroads: Change and Innovation in Dental Education. An important element of this reform has been the introduction into academic dentistry of active learning strategies such as problem-based and case-based learning. As an aide to broadening understanding of these approaches in order to support their expansion in dental education, this article reviews the major characteristics of each approach, situates each in adult learning theory, and discusses the advantages of case-based learning in the development of a multidisciplinary, integrated predoctoral dental curriculum.

A case study on development of an integrated, multidisciplinary dental curriculum.

Calls for fundamental reform of dental education were made twice in the twentieth century. More recently, spurred by the work of the American Dental Education Association's Commission on Change and Innovation in Dental Education (ADEA CCI), North American dental educators have again begun advocating for major curriculum reform in order to develop in students the higher order thinking skills required for the contemporary practice of dentistry. This case study describes the process of curricular reform at one school designed to move from a traditional siloed curriculum to one that uses case-based, integrated multidisciplinary courses to improve teaching and learning. The process was broad-based and comprehensive and included a schoolwide values clarification exercise and agreement on desired characteristics of an ideal graduate. Stakeholders agreed that the reform curriculum should incorporate inter- and multidisciplinary courses, case-based and active learning strategies, and concepts from adult learning theory. The new curriculum model is comprised of five unique but related curriculum "strands," each managed by a small group of interdisciplinary faculty content experts. Challenges in the development and implementation of the reform curriculum are discussed, and an assessment plan is presented.

Assessing the demand and preferred format of a student leadership development program at Pacific.

Dental students are future leaders of health care and the dental profession. The purpose of this study was to assess the interest in leadership development programs at the University of the Pacific Arthur A. Dugoni School of Dentistry and compare the results with similar studies. In April 2010, two surveys were administered. Of the 462 students enrolled, 58 percent completed the survey. Of the eighty-one faculty members and administrators who attended the Spring Faculty Development Day, 85 percent completed the survey. This study confirmed claims that students find it most effective to learn leadership from mentors. Over 80 percent of the student respondents indicated that faculty mentorship would be the most beneficial aspect of a leadership development program. Sixty-two percent of the faculty respondents said they would serve as mentors. Following mentorship, small-group discussion (74 percent), public speaking (56 percent), dental society member mentorship (40 percent), panel discussions (39 percent), community outreach (39 percent), and capstone project (13 percent) followed in popularity. This study established a foundation to develop a pilot for the Dugoni Practical Leadership Initiative at Pacific based on the preferences of the participants in this survey. With more data and longitudinal studies, we will assess how these programs translate to leadership in dental school and after graduation.

Review of outcomes from a change in faculty clinic management in a U.S. dental school.

Dental schools use a variety of clinic management models with the goals of promoting patient care, student education, and fiscal responsibility. In 2004, the University of the Pacific Arthur A. Dugoni School of Dentistry transitioned to a more generalist model with these goals in mind. The purpose of this study was to evaluate the outcomes of this clinic model change relative to the quantity of specific procedures completed by students. The quantity of procedures completed by each student from the classes of 1995 through 2009 were compiled from our electronic clinic management system and analyzed. The post-transition group (2004-09) showed a greater number of completed oral diagnosis and treatment planning and root planing procedures per student compared to the pre-transition group (1995-2003), but fewer crowns, root canals, operative procedures, and dentures. Because the higher procedure numbers were for low-cost procedures, our transition to a generalist model did not necessarily enhance clinic income but may support student learning and enhanced patient care.

Life balance and the busy dental professional.

The busy life of a dental professional demands we strive for a balance of time, energy, and interest to help ensure healthy and fulfilling personal and professional lives. Ideas supporting the commitment and planning necessary to achieving this balance are explored with specific focus related to our stage of practice.

The origins of fear of occupational exposure in the clinical dental setting.

Although there is a growing literature on the incidence of occurrence and reporting of occupational exposures in clinics in dental schools, the contributing factors to fear of such injuries and their dynamic evolution over time remain unstudied. It is hypothesized that fear of occupational exposures is a function of estimated likelihood of such events and their perceived importance. Individual personality factors and situational circumstances are also thought to play a role, although it is believed that these factors recede in importance as students gain direct knowledge through clinical experience. Path analysis methods are applied to longitudinal survey data in a single dental school to confirm these hypotheses.

Student occupational exposure incidence: perception versus reality.

Reports of clinical injuries made to a dental school Office of Occupational Health and Safety at the time of their occurrence were compared to self-reports on a survey for dental students in five classes at various times over their educational careers. The majority of injuries were from needlesticks and mishaps with hand instruments. Underreporting at the time of injury was approximately one-third in the first clinical year and one-half in the final clinical year of the three-year program. Students reported a greater perceived likelihood of injury later in their education than at the beginning but a decreased fear of such injuries. Female students reported more needlesticks and a greater fear of injury than did male students. It is hypothesized that a personal interpretation of the meaning of clinical injuries influences reporting behavior.

Educating the practice-ready dentist.

The mission of the University of the Pacific, Arthur A. Dugoni School of Dentistry is to graduate competent beginning dentists in a humanistic environment. As the first American dental school to incorporate competency-based education, it takes very seriously the understanding that competency means having the skills, understanding, and supporting values to begin independent practice. Competency is defined by the demands of dental practice, not by what professors know. The university's mission statement is to "provide a superior, student-centered learning experience integrating liberal arts and professional education, and prepare individuals for lasting achievement and responsible leadership in their careers and communities".

Perceptions of dental schools from within and outside the university.

Perceptions of dental schools held by high-level administrators of their parent institutions and officials in the local community have great potential to influence the future of dental education. The intent of this investigation was to gain a preliminary knowledge of such perceptions at seven institutions in the United States and to use this information to formulate hypotheses that can provide the basis for further targeted investigations that provide evidence useful in decision making and planning processes within dental schools. Interviews with university administrators, executive directors of state dental associations, and state government officials in seven areas of the United States were conducted. The hypotheses drawn from these interviews are: 1) dental schools are generally too insular and need to interact more with their parent institutions and external community; 2) dental schools need to systematically and continually get the message of the value of their services out to the public and political constituencies; and 3) multidisciplinarity and integration with other units are important to university administrators but largely outside the concerns of those external to the university. We suggest that these hypotheses form the basis of subsequent, more targeted, follow-up investigations with the intent of formulating specific recommendations for action.

Evaluation of a clinical outcomes assessment tool in a U.S. dental school.

Quality assurance (QA) programs in dental schools have a component of their program devoted to treatment outcomes. To this end, our institution has implemented TOUCH (Treatment Outcomes Unacceptable for Clinical Health) seminars and Unusual Occurrence Reports (UORs). The seminars allow a faculty member to present a case to faculty and students with feedback from the audience on how the case was managed. The UORs track clinical incidents outside the range of normal. Participation in both of these QA measures has been less than expected. The goal of the current study was to discover the reasons for participation and lack of participation. A twelve-item survey was completed by seventy-one clinical faculty members and analyzed for trends. Faculty report only 28.3 percent of the unacceptable outcome cases they know about. The two most common reasons given for reporting an unusual occurrence were that it would help the institution reduce similar incidents and it would provide an opportunity to share learning experiences. The most common reason given for not reporting an unusual occurrence was not remembering to do so. Faculty members were most willing to present a TOUCH seminar if guaranteed that no negative repercussions would result. Suggestions for increasing participation in both programs include emphasizing their value, modifying the seminar format, providing more reminders, and reassuring against repercussions.

Quality assurance and risk management: a survey of dental schools and recommendations for integrated program management.

Quality assurance (QA) and risk management (RM) programs are intended to improve patient care, meet accreditation standards, and ensure compliance with liability insurance policies. The purpose of this project was to obtain and disseminate information on whether dental schools integrate QA and RM and what mechanisms have been most effective in measuring accomplishments in these programs. All sixty-five U.S. and Canadian dental schools were sent a twenty-nine-item survey, and forty-six (71 percent) schools responded. The main findings are as follows: 66 percent had a written QA program combined with a QA committee; 95 percent received administrative support; there was wide variation in the makeup of the QA committee; many institutions reported significant changes resulting from the QA program; and over half of the respondents merged QA and RM in some fashion. To develop or maintain an effective QA/RM program, the authors propose the following: obtain active support from the dean; develop goals and mission/vision statements; include trained personnel on the committee; establish wide levels of involvement in the QA program; develop QA measurements to ensure compliance with institutionally developed standards of patient care; and establish continuous cycles of improvement.

Debt and practice profiles of beginning dental practitioners.

Escalating student debt for dental education has led some to speculate that beginning practitioners may undertake procedures that are beyond their competence in an effort to augment practice income. This hypothesis was tested directLy using a data set containing self-reports of practice profiles across a wide range of procedures and debt for education, practice, and personal purposes. Respondents were 113 individuals who had graduated from a private dental school from 1986 to 1997. Conservative dental practice was measured by comparing frequency of commonly and uncommonly performed procedures in the group as a whole against the profile for each respondent. There was no association between educationaL debt and propensity to engage in unconventional procedures. Older dentists and those who felt more competent at the time of graduation were less conservative. Amount of practice debt was a better predictor of unconventional practice than was educational debt.