The Need for Reform in Dental Education
In August, 2004, Santa Fe Group convened a conference in San Francisco to explore what is widely perceived to be a crisis in American dental education and to plan strategies for transforming the system which trains the nation’s oral health care professionals. The ultimate objective of the conveners is to stimulate reflective thought and action on the part of dental educators and others to produce oral health professionals better equipped to deal with the health care realities they will face in the future.
Contemporary dental education remains rooted in training models developed nearly a century ago. Dental schools, in particular, struggle with curricula, enrollment practices, and faculty resources which are often poorly suited to deal with the needs of our rapidly changing society. Such factors as immigration, aging and associated chronic diseases, increasing disparity in health and access to care, and myriad others present significant challenges to dentistry today. At the same time, scientific advances in such fields as genomics, proteomics, pharmacotherapy, and systems biology are redefining the way disease is perceived, diagnosed, and treated. “How best to respond to these demands?” is the question facing dental educators today.
To begin exploration of that question, Santa Fe Group invited more than 50 leaders from the academic, corporate, governmental, professional, and funding communities. Nine external sponsors joined Santa Fe Group in sponsoring the conference, including the Brasseler USA, Colgate, Delta Dental Plan of Massachusetts, the Dental Trade Alliance, DENTSPLY, International, GC America, Henry Schein, Inc., Patterson Dental, and Procter and Gamble. Working from the generally acknowledged premise that dental education must be transformed, participants joined in nearly two days of focused discussion to develop a series of short and long-term strategic actions which could significantly alter the course of dental education.
Meeting at the newly designated Arthur A. Dugoni School of Dentistry at the University of the Pacific, Drs. Dominick DePaola and Hal Slavkin, both Santa Fe group members, set the context for the meeting with an overview of their white paper, “The Necessity for Reform in Dental Education.” In addition, participants reviewed five topic areas from which models for dental education can be derived. Briefing papers and oral presentations on these models include:
- “Community-based education: a view from the trenches,” Dr. Jack Dillenberg
- “The pipeline project and social engagement,” Dr. Allan Formicola
- “Technology and distributed education,” Mr. James Galbally
- “Corporate funding,” Dr. Howard Landesman
- “Medical-dental models in dental education,” Dr. David Nash
Calling the conference the “beginning of a revolution from within,” Santa Fe Group President, Dr. Lawrence Meskin explained that the organization wanted to act as a catalyst to influence change by providing a forum in which health care professionals, policy leaders, and decision-makers could come together in a neutral environment to share opinions freely, without concerns about institutional loyalties and constraints.”
Repeatedly, participants noted that oral health reports and educational commission studies consistently forewarned of the problems dentistry now faces. One such document is the Surgeon General’s first report on Oral Health in America, published in 2000. This report spotlighted the growing crisis in oral health care and set forth a social rationale for the sorts of actions discussed in the San Francisco conference. Calling oral diseases a “silent epidemic,” the Surgeon General’s Report documented that oral and systemic health problems are often associated and that oral diseases and disorders can compromise health and well-being over a lifetime. The Report further concluded that solutions to these problems are hindered by issues involving oral health disparities, the relative inability of the public to benefit from scientific advances, the tenacity of barriers to care for growing segments of the population, and the erosion of the dental workforce by aging and retirements. Further exacerbating the situation is the fact that the current dental education system is threatened by escalating educational costs and mounting student indebtedness.
Conference participants determined that the single most important factor responsible for the crisis in dental education is the “silo” approach so commonly found in health education. By their reliance on independent curricula, faculty, facilities, and research programs, “silos” contribute to the isolation of health professional training programs. A more effective outcome could be achieved, speakers hypothesized, if dentistry were integrated in a comprehensive, interdisciplinary health care education system.
The Santa Fe Group conference is seen as an important first step in the journey toward a broad-based national effort to overhaul dental education. “The fact that 80 percent of dental disease occurs in 20 percent of the population, that 110 million Americans lack dental insurance, and that there is a growing shortage of dentists to treat the needs of certain populations – especially children – obligates us to move quickly toward reform,” said Dr. Hal Slavkin, as he urged participants begin implementing change strategies in their home institutions and organizations.
Eyes on the future, Slavkin and other Santa Fe Group members have articulated a vision for the goal of an “ideal” oral health education system:
The mission of the oral health education system of the United States is to serve society by educating and training a diverse workforce capable of meeting the Nation’s need for oral health care. Members of this workforce should variously engage in clinical oral health care, public health practice, biomedical and health services research, education, and administration. Oral health professionals should also contribute to the fields of ethics, law, public policy, government, business, and journalism. The educational system will meet its unique responsibilities to educate and train highly competent clinical practitioners by ensuring that they acquire, and sustain throughout their careers, the knowledge, skills, attitudes, and values needed for practice within interdisciplinary health care teams. These skilled health care providers must have the ability to provide complex, integrative, high-quality care for patients, families, and communities. To do less is an abrogation of the professional covenant extended to dentistry by society.