By Dr. Elisa M. ChÁvez Luna
Even the most forward-thinking, outward-facing institution needs to periodically take the time to reflect. As the Arthur A. Dugoni School of Dentistry maps its new strategic plan to Transform the Future of Dental Education, we reached out to several leaders in organized dentistry and academia to get their perspectives on where we have been and where we are headed as an educational institution and as a profession. Certain themes surfaced, including changing demographics, ongoing disparities in health care, new expectations for dental education, access to dental care and changing models of practice, reimbursement and the value of oral health care.
What has been the biggest challenge to dental education in the last 20 years?
We asked Dr. Mike Alfano, president and founding member of The Santa Fe Group and dean emeritus of New York University School of Dentistry, for his perspective on the biggest challenge to dental education in the last 20 years. Although difficult to choose just one, Alfano pointed to the limited success of recruiting a diverse group of dental students. “We are not much better off in the diversity of underrepresented minorities.” Disparities in oral heath tell us that certain groups and populations of people have more unmet needs than others and often these same groups are also underrepresented in the dental profession. This can create a barrier to care in some communities and young people in these communities lack role models to follow into the profession.
Dr. Nader A. Nadershahi ’94, dean of the Dugoni School of Dentistry and Santa Fe Group member, agrees that this has been an issue and emphasized that continued awareness and effort is needed to recruit a more diverse faculty as well. He points to an up-and-coming diversified faculty workforce as one of the bright spots in the future of dental education. “The increasing diversity in all forms, including gender, ethnicity and previous experiences, will allow our nation’s faculty to provide the mentoring and leadership needed to inspire the next generation of oral healthcare providers as they create the innovative solutions in scholarship and teaching and learning environments that will keep our nation’s academic health institutions at the forefront among our global colleagues.” The Dugoni School of Dentistry is dedicated to the recruitment and retention of a diverse faculty in order to bring innovative ideas and create new role models in leadership while attracting and inspiring a more diverse student body.
The Dugoni School of Dentistry is dedicated to the recruitment and retention of a diverse faculty in order to bring innovative ideas and create new role models in leadership while attracting and inspiring a more diverse student body. — Dr. Nader A. Nadershahi ’94
When we asked Dr. Rick Valachovic, president and CEO of the American Dental Education Association, for his pick as the biggest challenge to dental education in the last 20 years, he responded, “It has been finding our place in the broader worlds of higher education and the health professions…. and …a tradition of isolation from the academic health center and the university.” He continued, “Dentistry has discovered the roles that we can play as a learned profession in the academy. As a successful example, one needs to look no farther than the Arthur A. Dugoni School of Dentistry and its strong relationship with the other schools and administration of University of the Pacific.”
Our strong relationship with our University can empower us to change paradigms in dental education and advance interprofessional collaboration beyond traditional realms of health care.
What changes in dentistry and health care will have the greatest impact on dental education?
Dean Nadershahi sees changing paradigms in health care, education and the role of dentistry as potentially having the greatest impact on dental education and the greatest potential impact on our school. “Increasing our understanding of the importance of oral health to overall health and well-being in all stages of life will continue to shift practice models, reimbursement models and educational systems. This will require the educational system at the Dugoni School to graduate leaders prepared to help move our profession into a new golden age of health where our graduates will be recognized and reimbursed for the great value they bring to person-centered and community-centered health.”
Marko Vujicic, chief economist and vice president of the Health Policy Institute at the American Dental Association, feels that it is imperative “to resolve once and for all the disconnect between promoting oral health as critical to overall health, as dental care is core to primary care.”
Students must be taught their role as team members and learn the roles of others to become a part of and to lead successful teams. — Marko Vujicic
In order to establish dentistry’s role in the broader health professions, we cannot teach students that oral health is a critical component of total health and wellness yet send graduates into practice with the idea that they may exist independently from the rest of the healthcare system. For those committed to private practice, their business and practice models must be developed to compete and collaborate with larger enterprises. Dentists who are prepared to reach into their respective healthcare communities and to function as an integral component of comprehensive health care will be critical to individual success and to our collective success in demonstrating that oral health is not an elective element in health and wellness.
Vujicic added, “If you want to train clinicians to become leaders of oral health teams, able to supervise other dentists, hygienists, collaborate with physicians and community health workers, but not necessarily tied to doing restorative dentistry all day, you have to rethink your curriculum.”
Students must be taught their role as team members and learn the roles of others to become a part of and to lead successful teams. This does not diminish the importance of excellent clinical skills for which Dugoni School of Dentistry has and will continue to be known. New practice models can free those who wish to focus on clinical skills. And importantly, practitioners with strong clinical skills and knowledge, combined with a broad foundation in medicine and experience in the provision of health care as part of a team will help shape standards for quality in dentistry and medicine.
Peter DuBois, executive director of the California Dental Association and Santa Fe Group member, said, “Dentistry tends to lag behind other medical disciplines in providing and measuring the quality of care received. As our healthcare system continues to change for both political and financial reasons, and dentistry is considered for integration with healthcare delivery systems, it is reasonable to assume that payers and patients/consumers will expect some uniform quality/outcomes metrics.”
Valachovic believes that dental schools can improve both the quality of care and education by evaluating the impact from technology, practice models and consumerism in dental school environments. The Dugoni School of Dentistry must prepare graduates to define and achieve outcomes in health and wellness in a broad healthcare environment.
Do you think the institutions in California have any opportunities or challenges that institutions in other areas in the country do not?
DuBois reflected on the opportunities and challenges specific to California institutions and how they could be leveraged to benefit our state and dental education. We are challenged by an expensive location and high cost of living. In addition, the cost of living adds to the total educational expense; and for those who wish to practice in urban areas, professional competition is intense. But our location and resources are still a draw to many people, and in particular to Millennials who are often drawn to urban areas.
“Fourteen million Californians—half of all children and a third of all adults—are eligible for care through the state’s Medicaid dental program, Denti-Cal,” said DuBois. “The recent approval of Proposition 56 is expected to help improve access to care through additional funding for the state’s office of oral health, restoring full adult Denti-Cal benefits and increasing provider reimbursement rates. By serving California’s Denti-Cal population, dental school students can hone their clinical skills and gain an improved understanding of the unique needs required of this population while providing much-needed dental care.”
Fourteen million Californians—half of all children and a third of adults—are eligible for care through the state’s Medicaid dental program, Denti-Cal.
— Peter DuBois
Alfano views access to affordable dental care as one of the biggest challenges to our profession and society over the last 20 years and believes we have a long way to go. Nadershahi believes having six strong dental programs in our state represents an opportunity for the deans and academic leaders to share ideas and resources and leverage their positive partnerships with the California Dental Association to improve education and access to care as an opportunity. “By working collaboratively, we can address the major issue of the rising costs of delivering high quality education for our students and care to the underserved in our communities,” said Nadershahi.
What are the three most important things we can do as an institution, right now, to prepare ourselves for the future?
Dr. Cindy Lyon ’86, associate dean for Oral Health Education at the Dugoni School of Dentistry, explained that she has a vision for the Dugoni School’s educational program which includes: 1) moving from mechanically based to biologically based therapies; 2) teaching our students how to work in an interprofessional, collaborative environment; and 3) stressing the acquisition of knowledge, skills, values and problem-solving abilities in equal measure. Additionally, Lyon and several leaders suggested that providing alternative learning formats such as small groups, online learning and experiences that model success in collaborative environments are needed. Many respondents noted the importance of recognizing that the interests, views and expectations of new generations are different from those of generations that came before. We need to provide them with the support and the skills they will need to negotiate a rapidly changing and increasingly integrated healthcare environment with integrity and excellence.
While we address internal pedagogy and culture, we must also have the courage to address external influences and forces. Nadershahi believes we must foster closer bonds and working relationships between all stakeholders focusing on oral health including but not limited to our profession, education, licensing bodies, legislators, funders, community partners and others. He also believes we should define the most important outcomes measures to assess the value we bring to a person’s and population’s health and clearly define the role and value of oral health as a critical lead in the overall health of our communities and healthcare delivery models.
What can the Dugoni School of Dentistry offer to the future of dental education that others cannot?
This final question was posed to Dean Nadershahi. “The Dugoni School has a rich history of creating a humanistic culture and learner-centered educational models. This focus and history will help lead the changes necessary for the future of oral health education and newly evolving collaborative care models.”
The Dugoni School of Dentistry experience, preparation and expectation to apply a humanistic approach in practice and leadership can give our graduates an advantage in any practice model. Our purpose at the Dugoni School is to help people lead healthy lives and with that in mind, we can’t wait for the future as our future is now.
Dr. Elisa M. Chávez Luna is an associate professor in the Department of Diagnostic Sciences and serves as chair of the Strategic Planning Oversight Committee.