The Pacific Paradox

Of course the world has changed. It’s bigger, louder and faster. It’s more complex. It’s more volatile and chaotic, more detached and indifferent. Yet, ironically, the world may also feel smaller and more personal, particularly online where people can operate in more virtual shared space than ever before. These days, especially to Millennials—the first Internet natives— such contradictions can be disorienting. Young people who would rather curl up with Tumblr on a Friday night than go out dancing might find an expansive, real-world setting, such as the wide-open meeting space of a dental school lecture hall, to be an alien environment, one quite inimical to the comfortable give-and-take that a real-time discussion requires.

So what does an enterprising Dugoni School of Dentistry educator do when she finds few students speaking up in class? She embraces the new complexities, of course. She plugs into the technology and recalibrates the impersonal to the personal. Dr. Natasha Lee ’00, who became course director of jurisprudence and practice management in 2012 after a dozen years teaching pre-clinical operative dentistry, discovered that students were hesitant to respond to her questions during big-group lectures. “Students these days communicate differently,” she says. “They don’t raise their hands or engage publicly the way they used to.” So Lee offered her students another option. She bought a second cell phone on the cheap and gave out her phone number to the astonished class. Text me your questions, she said. And they did.

[pullquote]“Students these days communicate differently,” Dr. Lee says. “They don’t raise their hands or engage publicly the way they used to.” So Lee offered her students another option. She bought a second cell phone on the cheap and gave out her phone number to the astonished class. Text me your questions, she said. And they did.[/pullquote]

Much has changed in the dental school: a new campus, a fresh organizational approach and the vaunted Pacific Dental Helix Curriculum. Technology has escalated student-faculty interaction: passive classroom note-taking has given way to electronic information transfer, freeing up time for more active intellectual pursuits such as literature search, examination of evidence, discussion and reflection. “Twenty-five years ago the discipline was simpler,” says Dr. Cindy Lyon ’86, chair of the Department of Dental Practice and Community Service, “and scientific data wasn’t available 24/7 online. Learning has become a more sophisticated process today.”

The students have changed as well. Gone are the rote information exchanges endured by docile undergraduates slumped in stadium seating, biding their time and biting their tongues. Today’s future dentists engage directly with their education. “Students work super-hard and also place a high priority on life balance,” Lyon says. “I remember surrendering ourselves to the process, assuming that we’d resume ‘real life’ after graduation.”

Lyon notes that dental students these days are well-prepared and confident expressing their views, immersing themselves in school decision-making processes and participating in faculty-candidate interview groups, strategic planning, special projects and standing committees. “Humanism is alive and well,” she says. “Student, faculty and staff attitudes remain positive and exceedingly can-do. Students are perhaps more intentional and participatory in this cultural element than I remember being. I was simply a happy recipient of the good vibes.”

But the biggest change that an alumnus from the 1980s or 1990s might sense as the institution grows—embracing both more real estate and an increasingly complex, demanding curriculum—is, paradoxically, a certain scaling down. As complicated as the dental profession has become, Pacific Dugoni’s resources, as if mirroring the immense-yet-intimate availability of the Internet itself, remain comfortably within reach. As sophisticated as dental education has become, the school still feels personal.

One critical element that keeps the multiple moving parts of the Dugoni School of Dentistry’s ambitious program accessible is a unified interdisciplinary approach to learning. Integration, which forms a fundamental underlying theme of the new Pacific Dugoni, is central to each student’s experience from the first day of school. Preclinical dental anatomy, fixed prosthodontics and operative dentistry are now taught together as one big course. The biomedical sciences are also integrated by systems; physiology and anatomy courses line themselves up to present, for example, cardiology at the same time. “Students really respond to that kind of coordinated effort,” says Dr. Bill Lundergan ’81, chair of the Department of Periodontics, whose daughter Jenni is a member of the Class of 2015. “Jenni seems less stressed than I was.”

Team teaching also unifies the specialties. The updated curriculum calls for joint specialty seminars, in which several faculty together lead theme- and case-based discussions. “We put an endodontist, a periodontist and a general practitioner in the same room together to consider specific problems,” Lundergan says. “If there’s disagreement, the students can hear the instructors work through their various perspectives.”

[pullquote]But the biggest change that an alumnus from the 1980s or 1990s might sense as the institution grows—embracing both more real estate and an increasingly complex, demanding curriculum—is, paradoxically, a certain scaling down.[/pullquote]

But the biggest change that an alumnus from the 1980s or 1990s might sense as the institution grows—embracing both more real estate and an increasingly complex, demanding curriculum—is, paradoxically, a certain scaling down.

A more intimate scale also translates into more compact classes. Course directors have slimmed down an array of traditional large lectures into more tightly bundled and focused groups. “We’re doing far more small-group seminars with 18 to 35 students,” Lundergan says of a teaching strategy that encourages direct engagement with students and embraces greater emphasis on evidence-based dentistry and self-assessment. “Millennials like group interactions.”

For example, Lundergan directs students to develop reflective portfolios, in which they write about their experience in clinic, formulate a question based on their experience, conduct a literature search to answer the question and discuss how they will approach the problem they have investigated differently in the future. Lundergan acknowledges that while evaluating reflective portfolios are quite time intensive for faculty, the process, which helps students gain confidence in their own problem-solving ability, is also gratifying for faculty members. “It’s more difficult, but it’s more fun and more satisfying,” he says. “I learn something when students write a good reflective paper.”

The preclinical simulation lab, designed for a seamless transition to clinic, has been updated to sync with the real world. Sim lab chairs and lights match those in the clinic, and manikins, dramatically updating the time-honored teeth-on-a stick arrangement, offer both broader and more authentic  opportunities for training. “Because the sim labs are set up to allow a realistic practice and patient care experience,” says Dr. Nader Nadershahi ’94, executive associate dean and associate dean for academic affairs, “students can practice not just preps but appropriate responses to whole-patient concerns, including medical emergencies.”

The clinic has been reconfigured to run on a consolidated, holistic model. In place of the three group administrators who traditionally scrambled to cover the needs of the entire student body, these days eight group leaders each head up a smaller group practice. Significantly, the administrators are general dentists. “The trend is to a pure group practice model in clinic, headed by a generalist,” Nadershahi says, pointing out that the resulting agility encourages experimentation and comparison, accommodates upgrades of technologies and lets faculty manage the teaching experience in many different ways, even those currently unimaginable. “Flexibility,” he says, “helps plan for the unknown.”
[pullquote]To facilitate this brave new collaborative world, faculty members are intensively cross-trained across specialty disciplines, allowing an oral surgeon to appropriately direct students responding to endodontic situations.[/pullquote]
Under the generalist model, Lundergan observes, “Students get a better feeling for what should feel comfortable, of not only how to treat but when to refer.” Additionally, the specialty parts have largely cohered with the clinical whole. “Under the old system,” Lundergan says, “we would teach with separations, each specialty inside its own cocoon. Now the departments, specialists and generalists work together.”

To facilitate this brave new collaborative world, faculty members are intensively cross-trained across specialty disciplines, allowing an oral surgeon to appropriately direct students responding to endodontic situations. As a result, procedures in the realms of periodontics, endodontics and basic oral surgery—such as extractions—are now being performed on the clinic floor, as individual needs arise, instead of being relegated to specialty areas. Such interwoven curriculum strands allow and encourage faculty to plan and talk with each other, supervising the students’ learning experiences together. Their goal is for students to manage as many situations as possible, to appropriate levels of complexity, without having to chase down specialty consults. “We want students to work as they would in practice,” says Nadershahi.

Remember the emergency clinic? It’s a memory. Nowadays, each group practice manages its own emergencies, allowing students to experience the consequences of their treatment decisions and performance immediately and directly. “If a student places a bad temp,” Lundergan says, “He or she will find out right away and remedy the situation himself or herself.”

Patients also become part of a specific group practice, which is able to track recalls more efficiently. Students treat families of patients, from children to grandparents, each with different medical histories, social histories and personal issues. Consequently, faculty members and students discuss patient scenarios as part of their work—so instead of just doing a DO on number 19, they acknowledge and respect the person who goes with the procedure.

The physical layout of the new clinic reflects an enhanced agility; the spaces as unified as the learning systems they support. The Fifth Street facility comes equipped with spacious operatories and arranged as eight group practices, allowing patients to feel less like they are in a clinic and more like they are in a dental office.

Each group practice contains first-, second- and third-year students, who stay with the same group practice and leader throughout their education. Three generalists—the same three—remain with each group of students throughout their clinical experience, so instructors, getting to know every student well, can tell who’s strong or weak in a given area and tailor the educational experience to each student’s needs.

The new clinic model encourages students to actively assist each other. “We hope our new smaller group practice model leads third-year students to support and mentor second-year students in their group,” Lyon says, “both for teaching and learning reasons and to improve the group’s business outcomes.”

The dental school’s rescaled accessibility also offers students more choices. While once a tightly controlled curriculum allowed no flexibility in the undergraduate dental program, now students may select from several options, including courses in leadership, education and research. “The continuity, integration and creativity in Pacific’s evolving program,” Lundergan says, “yield remarkable results.”

When Lee assumed leadership over practice management coursework, she decided to revamp not only its content but also its style to match external environment transformations. “We used to have consultants rotate in and give lectures,” she says, “but the information was doled out in bits and pieces, without coherence or cohesiveness, and in a breezy, non-academic style.”

Inspired by business school online management simulations, Lee adapted one for her students. Teams of four formulate a mission statement and goals. Then they acquire a virtual dental practice, with all the issues that go with it, including human resource questions—wages, staff hours, staff turnover—and financial situations. They grapple with overhead, consider collections policies and generate profit and loss statements. The students can opt in or out of capitation plans and Medicaid; they can hire hygienists. They understand the intricacies of associateships, job searches and curriculum vitae. “Definitions are changing,” Lee says. “With corporate-supported models, even practice ownership doesn’t always mean what it used to.”

[pullquote]The physical layout of the new clinic reflects an enhanced agility; the spaces as unified as the learning systems they support.[/pullquote]

Lee’s students must respond to ethical dilemmas: perhaps a patient comes in and offers to bring in other patients if the dentist will waive the referring patient’s co-payments. Students also contemplate opportunities for volunteering and giving back to the community. “I love that this program introduces ethical discussions and social sensitivity,” Lee says. “Students discover they can take the ethical high road with every decision and still thrive.”

Via Dugoni School of Dentistry’s small groups, students can, among their other accomplishments, achieve profound wisdom. The school’s integrative, personal approach, along with a fantastic new facility, will benefit generations of students.

Eric K. Curtis ’85, DDS, MA, of Safford, 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.