Tag Archives: change

Discovering Who We Are

by Patrick J. Ferrillo, Jr.

Around here, we often say, “The greatness of Pacific Dugoni is its people.” No one can imitate what we do because no one else has built, over decades, a group so completely dedicated to making its school great. Others have yet to figure out that it is not just the faculty, the students, alumni or any other single factor. It is everyone continuously working together to reinvent ourselves.

Planning To Advance Greatness

I am proud of our strategic plan (which you can learn more about at www.dental.pacific.edu/Strategic_Plan.html). But the real story is how this plan was created, continuously updated and is being implemented. We are actually in the plan’s third stage; having framed the original plan and completed the implementation, we are now working on a revision of the plan. There is not a student, faculty or staff member or alumnus who has not been invited to participate, and literally hundreds of people have—in town hall meetings, via surveys, by making specific recommendations or joining writing groups, as well as assisting in the changes that have taken place in our curriculum, our teaching philosophy and departmental restructuring.

Dr. Alan Gluskin ’72, co-chair of the Department of Endodontics, who led the first Strategic Planning Committee, laughs as he explains, “We only accomplished half of our recommendations during the first few years of the original plan. Of course we had more than 200 recommendations, so half of that is pretty good progress.”

Our strategic plan is about reaching beyond boundaries.

The process has been as important as the product. After all, many dental schools have binders of strategic plans on shelves in somebody’s office. But using an inclusive approach to planning and implementation, rotating the leadership and guiding the process with professional outside consultants, we have increased our school family’s sense of ownership. Through the process of ensuring comprehensive participation, we have truly been discovering who we are.

Rethinking the Educational Experience

The term “curriculum” is almost obsolete here. That word conjures up images of isolated courses that are fit together in some pattern, often dictated by time and faculty considerations. Because we are competency-based, everything is now focused on students’ learning experiences.

Our strategic plan is about reaching beyond boundaries. It is focused on preparing oral healthcare providers for scientifically based practice through developing evidence-based decision making and critical thinking across the curriculum; calibrating and cross training faculty across behavioral, biomedical and clinical sciences; and increasing interprofessional collaborative opportunities. The Helix Curriculum is now in our genes.

We have moved away from merely teaching course content and toward providing a rich network of experiences designed to educate a balanced professional, who is not only practice ready today, but equipped to be so well into the future of the evolving profession. Sequences of small lectures have been replaced by large strands of integrated experiences. Currently in place are the preclinical, clinical sciences, medical sciences and clinical practice strands. A fifth personalized instructional program strand will promote student and faculty individualized personal development and is in the pilot-testing phase.

The goal is that both students and faculty members will grow in their ability to put together all their knowledge and skills and apply them to patient care. It is good to know the nuggets of dental knowledge and to have the technical skill to fabricate beautiful work. But the ultimate test is being able to deliver this in patient care. Thus, most instruction now — both in the clinic and the didactic portion of the program, and even into the community — is taught by teams of faculty members, and is case-based, interactive and participatory.

The curriculum is articulated as well as being integrated. Meaningful opportunities to integrate material are not left to chance. Each of the strands has or will have its own coordinator. Coordinating is a full-time job done by individuals who are not faculty members but are experts in managing learning; know how to use computers to deliver material and track outcomes; and are here full time to follow up on all the details. Faculty members are knowledge and skill experts; the coordinators manage the educational experiences by arranging logistics, teaching materials and evaluation.

Group Practice Clinic Model

The clinic model is also being reworked to deliver state-of-the-art care and outstanding patient experiences in a setting that resembles private practice. Pacific has always been at the forefront of dental education in this area. Jim Pride, when he was clinical dean in 1972, developed the concept of comprehensive patient care where patients are assigned to students rather than to departments. That approach has since been imitated by every other dental school. In 1998, then-Associate Dean of Academic Affairs Dave Chambers pilot tested a program to determine whether smaller clinic practices would improve care. Two randomly chosen cohorts of students and two faculty team leaders were chosen to determine what group size was small enough so students felt responsible to each other, and to see where private practice concepts such as team meetings, productivity monitoring and coordination of patient care across team members would make a difference. Although we were not ready to implement our finding at the time, the outcomes data demonstrated that this model, compared with the rest of the clinic, leads to significant improvements in student grades, patient satisfaction, clinic income and—most important of all—to objective measured improvements in patient oral health. We are now well into the planning and incremental implementation of this model.

We Need a Bigger Box

Innovations in our educational and clinical programs have caused us to run up against unexpected limitations. The building that was right for us 46 years ago is no longer up to the task. So we are moving on and forward.

Our new campus in San Francisco’s South of Market area addresses three needs. First, it will give us the flexible seminar and clinical facilities to support our new model of dental education. Second, it will open up a new patient base and a presence for the school in the heart of the City. Third, it is making us focus on the big picture. By the time the architects ask, “Where do you want this to go?” we already have had to think through the educational and patient care effects. Much like the strategic planning process that vitalized the entire school, planning for the move to Fifth Street has pulled together teams of faculty, staff, students and everyone else affected by the change to work through what matters and understand how the solutions for one group affect the way others operate. It is like putting on a new suit or a new dress. When we look in the mirror we see who we are in a new way.

The new building has also made it crystal clear that the Dugoni School of Dentistry is not an isolated community. We have a strong tradition of community outreach. Our new location will immerse us in a new community, with a different mix of patients. This pending move has reminded us of our University’s tradition of community collaboration and international exchanges. The need for the change and the opportunities it presents has not been lost on our alumni. The response from our rich network of former students and friends has been positive and has been demonstrated in very tangible support.

Global Footprint

Pacific Dugoni is expanding even beyond its new home in the heart of San Francisco. Our well-established and highly regarded International Dental Studies program has built our school’s reputation throughout the world. But consider opportunities on the ground in Alexandria, Egypt; Wenzhou and Beijing, China; Kuwait and Europe. We have formal exchanges with schools in all of these areas, ranging from hosting students and faculty, to tours, to an innovative program involving our AEGD program and the Benard School of Education on the Stockton campus and to resource sharing for degree programs in China. The students’ traditional dental mission trips have been brought under the school’s formal umbrella for purposes of coordination, insurance and supervision.

I have served as the president of the board of directors of the International Federation of Dental Educators and Associations (IFDEA) whose mission is to create a global community of dental educators joining together to improve oral health by sharing knowledge and raising standards. This has proven to be a robust platform for our faculty, students and alumni to share with their colleagues around the world.

Technology Matters

Before I arrived, the school had passed through the necessary stages of acquiring computers for a select group of technical experts and then equipping smart classrooms and clinics. We are now well into the phase of implementing technology for learners. We have installed AxiUm—a turnkey comprehensive record and management system—for all our clinics. The training for faculty, staff and students in how we use computers in patient care and in teaching is extensive. However, training is an opportunity as well as a cost. Education and patient care are now more responsive, more accurate and more coordinated. We have been more fortunate than most dental schools that must compete with other programs on a university campus for common resources. We have our own staff and resources, and they are outstanding.

An unanticipated benefit of technology has been the need to share and coordinate, as technology makes this easier. The days are rapidly disappearing when treatment of a patient in one specialty area could proceed without affecting other departments. Faculty members, who practice and teach one or two days per week, can now consult electronically on the care of patients who are here on other days. The clinical competencies of students needed in each quarter automatically feed the design of preclinical and didactic instruction. Faculty members can easily find out about what their colleagues and the students are doing. And, they can participate in planning and case management. All of this is translated into school-wide standards rather than departmental or individual ones.

Who Are We?

The strategic plan calls for three other broad goals: define new standards for education; discover and disseminate knowledge; and actualize individual potential. One might be fooled like the boy who watched the marching bands, the clowns and the elephants, and dignitaries but asked, “Where is the parade?” Pacific Dugoni is not a plan or the new building or a curriculum or a program: it is the people who do those things so well. Making the program better means building the potential of everyone in the building and the way they interact.

We have worked with the Stockton campus to deliver a doctoral program in education to almost a dozen faculty and staff. We are exploring a degree completion program for staff who need a few more courses to earn their first degree. Karl Haden and his Academy of Academic Leadership have a branch office on Webster Street (or so it seems). He has brought management expertise in planning and curriculum development and conducted about 15 days of basic teaching skills programs for faculty and staff.

The traditional lines in dental education that separate students, faculty and staff have held back dental education. These lines are being blurred at Pacific Dugoni. Faculty members are becoming learners, staff members are becoming effective managers and students are valuable resources for community health.

Recently, as I passed through Café Cagnone, I chatted with Drs. Frank Brucia ’44 and Irwin Marcus ’48 Ortho. I have seen them pouring over the portfolios of candidates for admission around the holiday season since I came to Pacific Dugoni in July of 2006. The conversation is always the same. “Dean, we must be doing something right. I just had an interview with one of the most qualified, actively involved and interesting young persons who wants to come here to be a dentist. And they just keep coming and they just keep getting better.” “Yes,” I say, “We are doing many things right. And I thank you and I thank all the others who make this happen. If you don’t stop, we are unstoppable.”

I can see the future of dentistry from here. It is who we are.

Standard Operating Requirements

By David W. Chambers

Several years ago I met a man who owns a car wash. When he found out where I work, he told me he had once wanted to be a dentist. In fact, he had been a student at P&S when it was on 14th Street. “I didn’t make it,” he said. “It seemed like all the professors wanted to show you how much they knew. And they didn’t mind telling you how little they thought I knew, and they weren’t very kind about how they did it.”

I told him things have changed. He didn’t seem bitter, just disappointed that he missed out on the transformation that former Deans Dale Redig and Arthur A. Dugoni made at Pacific, in dental education generally and in the profession. Our attitude today is “We’re very glad you are here; let’s develop you into a fantastic practitioner!”

The twin cultural changes go by the names of competency and humanism. The first views education as a learner-centered process for producing a professional ready for practice; the second is grounded in a community that respects the dignity and potential of all its members.

Although these sea changes both started at Pacific and have been nurtured here for more than 40 years, they are now standard operating requirements in every dental school in the United States. That is a bold statement, but one that has teeth. In 1997, the Commission on Dental Accreditation adopted standards saying that, “The stated goals of the dental education program MUST be focused on education outcomes and define the competencies needed for graduation, including the preparation of graduates who possess the knowledge, skills and values to begin the practice of general dentistry [Standard 2-4].“ The American Dental Education Association has adopted, by policy, a generic set of competencies; and all dental schools have developed ones that match their unique missions while honoring the core skills, knowledge and values of dental practice. These are not suggestions; all dental schools must operate this way now or they will lose their accreditation.

In July 2013, a new set of accreditation standards will go into effect, maintaining competency and adding humanism. All dental schools will be expected to maintain a “dental school environment characterized by respectful professional relationships between and among faculty and students … that inculcates respect, tolerance, understanding and concern for others.”

Competency

Competencies were introduced to dentistry in a 1993 Journal of Dental Education paper I wrote, called “Toward a Competency-Based Dental Curriculum.” Since then scholarship in this area has accumulated and other professional programs have adopted competency, including nursing, dietetics, business and optometry.

The process began more than a decade before the first paper when then Dean Dale Redig appointed me as director of the Introduction to Comprehensive Patient Care (ICPC) course. This is the Monday, all-day lecture-preclinical-clinical course during the first four quarters that gets students ready for their fast start in clinical care. It was an unconventional move by Redig to put a non-dentist in charge of the second-largest dental course in the program.

But it was critical for competency-based education. There was no way I could make students in my own image: I had to ask “the customers,” the department chairs and clinic administration, what they expected passing students in ICPC to look like.

The deep roots of competency can be traced to Harvard University’s John Carroll who advocated mastery education. No one should be allowed to move on to the next level until they have mastered the preceding steps. Stanford University’s Lee Cronbach also has his fingerprints on the idea. He was fond of saying that the prevailing approach to education was wrong because it standardized the method and expected a distribution of outcomes. He advocated instead that we fix the outcome and vary the methods.

Dr. Arthur A. Dugoni pushed competency-based dental education farther. In 1990, he appointed me as academic dean and made it clear he expected the competency system to be applied to the whole school. Part of the process was the so-called “big bucket” approach. Virtually all 10-hour lecture courses were combined into larger and more multidisciplinary ones. At the time, the policy of the American Association of Dental Schools (the forerunner of ADEA) was based on complete coverage of all that teachers in various disciplines felt comfortable teaching. This amounted to about four feet of curriculum guidelines and an estimated nine-year predoctoral program. The Curriculum Committee adopted a policy that the educational program would only be justified based on what dentists needed for practice rather than what faculty members wanted to teach.

Pacific’s competencies are posted on our website at www.dental.pacific.edu/x1867.xml. If they read a lot like the job description of a practicing general dentist, that is what they are supposed to be.

Although these sea changes both started at Pacific and have been nurtured here for more than 40 years, they are now standard operating requirements in every dental school in the United States.

Humanism

Humanism is not an educational process like evidence-based dentistry, problem-based learning, technology-assisted education, small-group discussion, vertically-integrated clinics or any other hyphenated methodology. It is a culture. It is who we are. Pacific changed its personality dramatically from the mid-1960s to the mid-1990s. In Dean Redig’s terms, it stopped being a place that tore people down. In Dean Dugoni’s terms, we started to grow people.

When Redig came to Pacific from Iowa in 1969 he found a culture of “toughness.” The College of Physicians and Surgeons was one of the last dental schools to meet the accreditation requirement for integration into a university. There were only a handful of full-time faculty members, and many of the part-time staff were organized into cliques. When William Gies visited P&S to prepare for his now famous Carnegie Foundation report: Dental Education in the United States and Canada, he characterized the school as having a “survivor mentality.” No eyebrows were raised when faculty members berated students in front of their patients. Unsatisfactory lab projects were destroyed on the spot as a kind of public entertainment. Students were dismissed in the middle of a term on nothing more than the suggestion to the dean from a department chair.

All deans until Redig had been insiders (one actually owned the school). The University wanted a change more than the faculty did. But it was obvious that the school’s conditional accreditation status could only be removed by curing the culture. Redig’s response was swift and structural. There were a few meetings, clear guidelines articulated, followed by a period of several months to see who would blink first. New faculty members were brought in to replace those who left. Part-time faculty members were required to take salaries so they could not remain a “fifth column”, and the number of faculty members was increased. Within a few years, a new foundation had been laid by professionalizing the faculty.

Redig had found students somewhat reluctant at first to become beneficiaries of humanism—and also wary of the possibility of getting caught in the middle of the tension between the dean and the faculty, of which they were clearly aware. There were other risks; the old system was more certain: survivors prospered. However, when they fully realized that Redig had meant what he said, and followed through with implementation of new rules and a new way of student, faculty and staff life in the school, they became strong supporters of the positive direction and change that had been put in place.

The second phase in converting Pacific’s culture to humanism was much more gradual and systemic. Dugoni was a product of and understood the old ways at P&S, but he was not sympathetic to its demeaning tendencies. In fact, at one point in his early, part-time teaching career, he had been threatened with immediate firing over his grading practices.

Dugoni focused on the student dimension of humanism. He made students partners in bringing about the humanistic culture. He met with students constantly, in small groups, several-hour meetings that demonstrated his willingness to listen and thus communicate respect, regardless of the details of the conversations. He learned student’s names, and the names of their patients and their children. He was saying, trust first, and then we can do business. It just made sense to Dugoni that students have a unique perspective on their situation and would accept responsibility for their education. The regular evening meetings between student and faculty leaders were notorious for Dugoni’s insisting that the dedicated and most concerned people regarding improving dental education at Pacific were in the room. If they could not make things better no one could.

Dugoni implemented formal changes designed to foster humanism as well. He directed me to lead all department chair searches, about 10 in all, and to oversee the hiring of all full-time faculty members. It was no accident that a criterion in every such search was “understands and respects the unique humanistic culture of Pacific.” That was often the deciding factor in who was hired and who was not. Dugoni also asked me whether anything could be done about student promotion standards. The old system, still used at some schools, involved dismissing students simply based on a low GPA. The new one began there but probed into why performance was below expectation and whether anything could be done to correct it. Contracts were written for students in trouble, requiring tutoring, counseling, diagnostic testing and retesting. Only when attempted remediation failed, or in a few cases, when students declined participation, would students be dismissed or asked to repeat a year.

Both Redig and Dugoni were fond of observing that the way students are treated in dental school shapes the way they will treat their patients, their office team and even their family once they graduate. Between 1995 and 2006, 176 practicing dentists had their licenses disciplined in California. Not one of them was a Pacific graduate.

We were fortunate in the selection and the order of our two previous deans. Redig’s decisive structural changes were needed to pave the way for Dugoni’s more gradual personal touch. The changes they created at Pacific made us all better and are now imitated by every other United States dental school.

I like to think that the fellow who runs the car wash was just the unfortunate victim of bad timing. If his likes were to come into Pacific today there is every reason to believe he would graduate a competent practitioner with a deep sense of worth and dignity.