Tag Archives: technology

Parag Kachalia ’01 | Process and Progress

Parag Kachalia was still a dental student at University of the Pacific when he realized that after graduating he would like to be a part-time dental school faculty member. So after graduation, Dr. Kachalia ’01 followed through with his plan and joined the dental school as a one-day-per-week faculty member in addition to seeing patients in private practice. This was the start of his evolving career as a dental educator.

About three years after joining the faculty, Kachalia was asked to consider taking the role of director of Preclinical Fixed Prosthodontics, one of the largest courses at the Dugoni School of Dentistry. After some deliberation he decided to accept the position along with a new commitment as a three-day-a-week faculty member.

“I never imagined I would have such a high level of faculty involvement, but I’m glad I took the path that I did,” says Kachalia. “Being an educator has made me a better practitioner, and being a practitioner has made me a better educator.”

Over the years, Kachalia’s commitment to the dental school has grown, but he has always maintained the private practice that he shares with his wife, Dr. Charity Duncan ’03, in San Ramon, California. He and Charity have started a family and Kachalia is quick to acknowledge that he’s able to be successful with his busy lifestyle due to the immense support of his family.

Something I love about Pacific is that we are willing to take calculated risks and reinvent ourselves when appropriate.

Currently, he’s vice chair of preclinical education, technology and research in the Department of Integrated Reconstructive Dental Sciences, which he admits is wordy, but is an indication of the multiple hats he wears as a faculty member. He oversees his department’s simulation courses for first-year students who aren’t yet treating patients in clinic, and he also serves as the school’s point person for information on and implementation of new dental technologies.

Kachalia, along with his dedicated team of faculty, are working tirelessly to modernize the school’s preclinical curriculum. In recent years, the dental school has modified its curriculum to better cater to millennial learners who respond positively to interactive academic environments and personalized learning experiences. Students are now being asked to think critically about patient care and treatment plans, not just to memorize procedures and perform them.

“There has been fear surrounding changes to the educational model because our current model does work well, but we want to make sure we’re staying up-to-date with the way students now prefer to learn,” he says. “Today’s students are able to absorb vast amounts of information and correctly filter it down to what is important. Our role as faculty members is morphing from giving our students information to memorize to helping them understand where to go to find information and then teaching them to evaluate it critically.”

The technology side of his position is equally progressive. Kachalia is involved with the school’s investigation and decisions regarding new technologies, and he guides the school’s commitment to implementing them. He’s also made it a priority to ensure the dental school becomes involved with the process of helping companies develop and test new technologies, not just adopting them years after they hit the market.

“I want our school to be viewed as the place to go for information on new dental technologies and techniques, and I think we’re getting there,” he says. “We have a growing number of faculty members and school leaders who are interested in setting the bar when it comes to new technology in dental education. I view Pacific as a center of excellence, a center that allows us to lead the path for the profession, rather than reacting to it.”

Kachalia concludes, “Something I love about Pacific is that we are willing to take calculated risks and reinvent ourselves when appropriate. I am thrilled to be a part of that growth process.”

Sending Signals: The Dugoni community embraces technology to communicate with patients

By Eric K. Curtis, DDS, MA

Dr. Nathan Yang ’06 was floored when his receptionist disappeared. Yang and his wife, Dr. Joanne Jeng ’04, had been thrilled about the practice they bought in San Francisco in 2008. But the excitement soon turned to dismay when the woman working the front desk left without warning, creating both a security breach and a practice management headache. Yang, who teaches part-time at the Dugoni School of Dentistry, thought long and hard about his options. Instead of hiring a new receptionist, he installed an electronic front desk.

Yang’s solution involves two separate Web-based services, Demandforce and ZocDoc, the latter of which was suggested to him by Pacific alumnus Dr. Jared Pool ’09. Together, the services create an integrated system for managing patient flow. The system puts Yang’s practice among the first five dentists in his zip code to appear during Google searches. It invites patients and potential patients to view available openings online. It prompts patients to make, confirm, cancel and reschedule their own appointments, or leave a message for his assistant to call them back. It then sends patients appointment reminders by email or text message.

This system, synchronized with the office’s existing scheduling software, allows Yang and his assistant to monitor their appointment books and interact with patients from any location. Much of this patient interaction occurs in the operatory. “My assistant can make appointments and handle patient questions while I’m looking at X-rays,” Yang says. The office computer generates recall reminders and even sends patients surveys via smart phone after appointments to gauge their experiences, transforming Yang’s patient base into a private, interactive social medium. “If I get a bad comment,” he says, “I have a staff meeting right away to fix the problem.”

The two services together cost less than $7,000 per year to maintain. “I realized I could either set up an electronic front desk,” Yang says, “or hire a new person at $25 an hour, with the accompanying ebb and flow of emotions that hurt us before.” With his virtual receptionist up and running, Yang discovered that his scheduling improved. Open spots filled up with less hassle. His no-shows dropped. “I haven’t really had a front-desk employee now for four years,” he says.

Yang concedes that some people are “weirded out” by his technological leap of faith. “It might seem sort of ‘out there,’” he says of his lack of a human receptionist, but insists he is technologically conservative. He doesn’t maintain a conventional website, or an office Facebook presence, and he doesn’t participate in crowd-sourcing platforms such as Yelp. “I don’t believe in tech for tech’s sake,” Yang says, “but I have to ask myself what’s reasonable. I want to be accessible.” His system, he says, is low key and professional, and not self-promoting: “There is no way my patients can’t get in touch with me. I’ve found a way to communicate without being overbearing. It’s fast, easy and discreet.”

The upshot is this: Nate Yang runs his practice over the Internet using his smart phone. Welcome to the brave new world of communications technology.

Dr. Parag Kachalia ’01, assistant professor and vice chair of pre-clinical education, research and technology in the Dugoni School’s new Department of Integrated Reconstructive Dental Sciences, keeps his finger on the pulse of technical innovation. Communication is the essence of both education and patient care, and the Dugoni School of Dentistry has worked hard to attune the flexibility and sensibilities of its humanistic philosophy to changing technologies. “We try to analyze not just what’s happening now but also anticipate conditions two to five years out,” Kachalia says.

What’s happening, of course, includes new technology. The dental school, which previously pioneered clinical studies of Invisalign®, is currently testing a system for digital dentures with a computer-based occlusal scheme. On the first appointment, the dentist takes a traditional impression and creates a jig to capture occlusal records; on the second appointment, the dentist delivers the denture.

Such technologies may improve both clinical practice and the quality of the educational experience itself. The 3M ESPE company recently donated to the school 12 Lava Chairside Optical Scanner (COS) devices, digital impression machines that let dentists produce a three-dimensional model of a patient’s mouth. The fact that students—bringing long-practiced video game-playing skills to bear—can easily manipulate the hardware to visualize the mouth’s hidden recesses in magnified 3-D signals a truly collaborative approach to education. Developments such as the COS, Kachalia says, “allow us to dramatically bring the intraoral environment out of the mouth and in front of everyone.”

But Kachalia explains that the dental school’s sensitivity to trends in technology also involves a close reading of how people accept and use that technology. Accordingly, instructors are exploring the educational opportunities of social media, preparing virtual classrooms on Facebook and experimenting with communications via a Twitter feed. (Email, it turns out, is so ten minutes ago—while electronic messaging used to be the vehicle of choice for rapid information exchange, people have become bombarded with spam to the point that many mostly ignore it.)

To be sure, social media represents both rewards and risks for dentistry with pitfalls lurking next to the promises. Facebook, as Kachalia describes it, may be “this generation’s gathering around the coffee table,” but confidentiality is a concern, as are implications for ethics and professionalism. “Facebook has great educational potential,” he says. “We need to learn how to properly navigate it and put up appropriate filters.”

Yang believes that one danger of social media for practitioners is the temptation to chase immediate gratification; some may see those communication channels as a vehicle for making quick money without consequences. Another risk lies in giving the public open access to pass judgment on a dentist’s practice. The instant interactions that social media provide invite raw, unvarnished comments that can severely affect a dentist’s reputation—comments that patient confidentiality laws prevent the dentist from fully addressing. When you give the world a free canvas to paint on, Yang says, “You have to take the bad with the good.”

E-mail, it turns out, is so ten minutes ago…

Yelp, the user review website, also presents a double-edged sword. While unedited patient testimonials can be a source of free advertising, the ability to post anonymously can provoke abuse, because, true or false, statements posted online may come to define a dentist. “Sites like Yelp, Twitter and Facebook are powerful tools,” Yang says, “that can quickly build or tear down your practice.”

“You can’t base your whole professional identity on whether you have two or four stars,” observes Kachalia, referring to Yelp’s rating system. “We need to be careful as a profession to create value within ourselves.”

One of the complications of this everyone-in-touch age is that communication is often multidirectional. “At school you have to bridge communications in a triangle, from faculty to students, then from students to patients,” Kachalia says. In one such bridge-building venture last year, the school introduced iPads, loaded with an application aimed at communicating with patients, into the Main Clinic. Students pull up the DDS General Practitioner patient education app to show photos, diagrams and animated images of common oral conditions and dental procedures, as well as present clinical findings, prevention recommendations and treatment plan options.

The electronic world has altered not just how students teach patients but how the faculty teaches students. Students today learn differently, Kachalia reflects. Having grown up in an environment of continuous stimulation, they may chafe at the traditional “sage-on-the-stage” lecture format. They are more comfortable with a two-way model of education. They want to be able to respond. More than just facts, they want applications. And because students have quick access to information, instructors must keep very current. “I can be lecturing,” Kachalia says, “and a student might be Googling to verify what I’m saying.”

Yet for all the potential insecurities that technology may serve up, even mature Pacific alumni remain enthusiastic about its possibilities. Dr. Kenneth Frangadakis ’66 is founding partner of a multi-specialty dental group in Cupertino, California, most of whose partners and associates are also Pacific grads. “As dentists,” he says, “we have to stay well educated and try to stay ahead of developments. If you are just keeping up, you’re falling behind.”

While Frangadakis admits he’s a “hybrid” dentist—“I write in the chart, and the staff puts it into the computer”—he keeps a careful eye on new developments. His current favorite clinical technologies include digital X-rays (“We’re upgrading from phosphor plates to sensors”), the iTero digital impression system and the Onpharma buffering setup for local anesthetic invented by Pacific alumnus Dr. Mic Falkel ’87, which Frangadakis liked so much that he invested in the company. “It really works,” Frangadakis enthuses. “The anesthetic is fast, it doesn’t hurt and it’s very profound.” The next piece of equipment on his list: “We need to get a three-dimensional imaging machine.” Frangadakis is also planning to incorporate an automated patient messaging software system, similar to Demandforce, called Smile Reminder.

Pacific alumni agree that no amount of technical innovation can compensate for poor patient care or sloppy interpersonal skills. “There is something to be said for treating people like family,” says Yang. “Regardless of technology, you still have to gain and keep people’s trust. You have to believe that it’s a privilege to treat people and an honor to make a living by helping people.”

“Successful practice is about giving value and service,” Frangadakis says. “Take care of people the way you want to be taken care of.”

Eric K. Curtis ’85, DDS, of Stafford, Arizona, is a contributor to Contact Point and is the author of A Century of Smiles, a historical book covering the dental school’s first 100 years.

Sea Change: New Small-Group Approach Planned for Main Clinic Mirrors Private Practice Model

By Dan Soine

A sea change is coming to the sea of chairs spanning the Main Clinic at the Arthur A. Dugoni School of Dentistry.

The physical expanse of the operatories looks impressive. New patients, visitors, students and others who visit the Main Clinic for the first time have a nearly unanimous reaction to its sheer size – it sure doesn’t look like any dental clinic they’ve ever seen.

But now the clinic is preparing for a major transformation. While the full expanse of Main Clinic operatories will remain in place, much of the organizational and behind-the-scenes structure of the clinic is changing in the next year.

Ultimately, these updates will ensure that the school continues its legacy of providing an outstanding, clinically based education to students, and comprehensive, patient-centered care to Bay Area residents in need.

“Creating clinically trained dental professionals is at the very heart of our school’s mission,” explains Dr. Richard Fredekind, associate dean for clinical services. “The new changes will keep us at the forefront of dental education and ensure that the clinical experience we provide remains second to none. Our clinics were good before, but with these updates, they’ll only get better.”

The most fundamental shift to come is a reorganization of the Main Clinic from four group practices into eight student private practices, each with its own practice leader (formerly known as group practice administrators or GPAs). The reduction in the average size of each practice will allow practice leaders to work even more closely with students than before.

Other changes are coming as well. The second- and third-year classes will be merged in the clinics. There will no longer be a separate second-year clinic or “second-year experience.” Students now will have two years of clinical practice at their individual learning paces, achieving competency in the various disciplines managed by their student practice leaders, and faculty within the practices.

In addition, first-year students will have an opportunity to gain additional exposure to the clinic. From the start of their first week, first-year students will get introduced to their student private practice and forge an even closer relationship with their practice leaders. They won’t be treating patients directly at this point, but will spend additional time getting familiar with the people, processes and procedures involved in patient care.

The changes to the clinics are the results of a planning process that started several years ago as part of the implementation of the school’s strategic plan, Advancing Greatness. More than 50 people were involved in two task forces to analyze how the Main Clinic can continue to refine and enhance its structure and processes to the benefit of patient care and student education.

A Model Adjustment

What’s driving these changes?

In 2008, the Dugoni School of Dentistry made a major philosophical and practical change to the way it educates its students through the development of the Pacific Dental Helix Curriculum. This new approach places a strong focus on active learning and critical thinking by integrating multiple disciplinary areas. The goal is to move toward small-group, case-based learning as a signature pedagogy. The process of developing the new curriculum also called for a complete review of the clinical practice model to make sure that this important component of the school’s educational program was staying on the leading edge of dental education.

“A major component of the development of the clinical practice strand of the Pacific Dental Helix Curriculum is to serve as the practical laboratory to integrate the practice management curriculum into the student private practices,” said Dr. Nader Nadershahi, executive associate dean and associate dean for academic affairs. “Students are not only learning to manage the diagnosis and delivery of care, but also the management skills to develop and maintain a productive practice.”

In early 2009, a task force was created to look at the existing clinical teaching model and make recommendations on the organization and management of the system. As part of its background work, the task force performed a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis of the clinic system. The group also discussed issues such as faculty coverage, student and faculty attendance, and differences in teaching between the second- and third-year clinics. A separate task force reviewed the resulting recommendations (See Master Plan sidebar) and developed an implementation plan.

The task force teams identified strengths in the current clinic teaching system that the new model retains or improves upon. These current strengths include excellent clinical training; a humanistic approach to education; comprehensive patient-centered care; the school’s generalist model and the use of specialists for difficult cases as in private practice.

Educational and Operational Benefits

The new clinical model is designed to be truly patient centered, stressing the “ownership” of the patient’s care by all treating and supervising team members. The new model will provide some flexibility in teaching and allow all members to capitalize on their personal strengths. It will also tie into the Helix Curriculum through the integration of clinical, biomedical, and behavioral sciences, and ensure careful supervision of patient care, with meticulous safety precautions during all clinical procedures. In addition, the new model will better ensure adequate patient distribution among students.

Delivery of services will also be adjusted. The services offered in the comprehensive care setting will be expanded to include simple procedures in the disciplines of endodontics, oral surgery, periodontics, removable prosthodontics, implants and orthodontics, which will decrease the number of referrals outside of the Main Clinic to other specialists in the school. This change will ensure continuity of care for the patients and also better reflects what happens in private dental practices. Furthermore, it will increase the value of the specialists, which in the new model will supervise only more complex procedures, where their expertise can be best utilized.

The new clinical model is designed to be truly patient centered, stressing the “ownership” of the patient’s care by all treating and supervising team members.

Under the new model, the screening and emergency care rotation will be absorbed into the normal student workload. This will allow students to treat and follow up with their own emergency patients. As in private practice, emergency patients will be seen when time allows. This means that students who have cancellations or “no show” patients can still have learning experiences. Patients will be screened by teams, which will allow faculty to assign new patients as needed within the team.

Another key benefit of the reorganized clinic model is the strengthening of team spirit, thanks to the inclusion of a strong leader who organizes huddles and monitors each team. A more hands-on approach will increase knowledge about individual students and allow for small problems to be handled before they grow to impact learning and patient care.

Another change will involve patient scheduling. Rather than having students schedule appointments on their own, the school is moving toward staff-managed and technology-assisted appointments. Lightweight laptops will be available for staff to use chairside to make next appointments for patients. Plus, touchscreen monitors have already been installed in the patient reception lobby for use by patients to check in. The electronic check in will be a more convenient and quicker way for patients to check into the clinic, compared to waiting in line at the lobby reception desk.

All of these operational changes are expected to increase chair utilization and decrease complaints from patients about not being seen by their own student dentists. The shift to smaller and more collaborative teams is also expected to lead to a decrease in waiting times for students looking for supervision by faculty. Thanks to these changes, the school expects clinic productivity to increase by 10%.

A Commitment to Delivering the New Model

The changes in the clinic model, and the resulting new policies and protocol, will require significant cross-training among faculty, staff and students.

“Everyone is interested in how the changes will impact them,” said Fredekind.  “We’re keeping the lines of communication open with students, faculty and staff as we move forward. We’re open to feedback and want to make sure that the overall implementation will ultimately enhance the experience of both students and patients.”

The dental school expects to fully implement the new clinic model by July 2012, with minor adjustments as needed subsequently. However, while the clinic will run differently, the changes do not mean an immediate end to the sea of chairs in the clinic. The switch to the new model will not be complete until after the school takes occupancy of new facilities in the future. Then, it will more adequately have physical space that allows for the new distribution of eight teams with physically separate clinic spaces.

While the school incorporates the new model within its existing facilities, there may be some bumps along the way. A sea change does not guarantee smooth sailing! However, the faculty, staff, students and administration are committed to this clinic transformation and excited about what the future holds for education and patient care at the school.

Dan Soine is Director of Marketing & Communications at the Dugoni School of Dentistry.