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JualhAcamdsusheucasWinter2013Volume1numBer1TheDenTaleDucaTionBuBBleAreWereAdyforALeed-StyLerAting WinTerJADEtheJournaloftheAcademyofDistinguishedEducatorsispublishedtwiceannuallybyNewYorkUniversityCollegeofDentistry.ExecutiveEditoreysBmanwYkuvstynwYknwYkEditorialBoardmye.ntdgPDmPhcnwYkuvstynwYknwYkeysBmaxffnwYkuvstynwYknwYkWedtsedDxffnwYkuvstynwYknwYkmtlppDDSnwYkuvstynwYknwYkaVtz-KDDSnwYkuvstynwYknwYkatyVDDSPDmBenwYkuvstynwYknwYkContributorscsn.BtDDSDmdSnwYkuvstynwYknwYkaJ.FDDSmScbuvstynwYknwYkrdByPDcbuvstynwYknwYkcpygtJy2013Ttstspbttwspftpygtftttbtwytdwdsptdfydstbtdpytttsgstgtsdstd.Volume1numBer1WinTer2013TThiscollectionofpapersmarkstheinauguralpublicationofanonline-onlyopen-accesspeer-reviewedjournaldedicatedtocriticaldebateonissuesaectingthefutureofhighereducationnotonlyintheUnitedStatesbutalsothroughouttheincreasinglyinterconnectedglobalcommunityofteachersinstructorslecturersandmentors.ThemissionoftheJournaloftheAcademyofDistinguishedEducatorsJADEistostimulateexcitementamongteachersaroundtheirintellectualcontentandtranslatetheperspectivesofleadingguresintheAcademyintorenewedinterestinlocalteachingpracticepurposefulchangedynamicinnovationandrigorousscholarship.ThevisionofJADEistopromotethefreeexchangeofideasregardinghighereducationaltheorymethodsandtools. 20133WhyJADEThetitleofthejournalreflectsitsori-gininthethink-tankmissionoftheAcademyofDistinguishedEducatorsattheNewYorkUniversityNYUCollegeofDentistry.1TheglobalnatureofitsoutreachisconsonantwiththeNYUGlobalNetworkUniversitythatisbothinandofthecityandinandoftheworld.2InordertopromotethefreeexchangeofideasJADEembracestheopen-accessmodelofthePublicLibraryofSciencewhereauthorsretainowner-shipofthecopyrightfortheircontentbutallowanyonetodownloadreusereprintmodifydistributeandorcopythecontentaslongastheoriginalau-thorsandsourcearecited.3Asapeer-reviewedjournalJADEascribestotheUniformRequirementsforManuscriptsSubmittedtoBiomedicalJournalsoftheInternationalCommitteeofMedicalJournalEditorswhichstatetheethicalprinciplesintheconductandreportingofresearchandproviderecommenda-tionsrelatingtospecificelementsofedit-ingandwriting.4Andfinallyasanonline-onlypublicationJADEoptsfortimelinessefficiencyandconservationoflimitedandvaluedresources.ThejournalisticandeditorialvaluesofJADEareeditorialindependenceoriginalscholarshipanddiverseandprovocativeviewpointsgroundedinstrongscience.InspiredbyAlbertGal-latinthedistinguishedstatesmanwhoservedassecretaryofthetreasuryunderUSPresidentsThomasJeffersonandJamesMadisonandwasafoundingfa-therofNYUJADEintendstoupholdthechargeofNYUinestablishinginthisimmenseandfast-growingcityasystemofrationalandpracticaleduca-tionfittingforallandgraciouslyopenedtoall.5FurtherJADEendorsesthegoalsoftheNYUAcademyofDistinguishedEd-ucatorstoenhancetheoverallteachingmissionoftheNYUCollegeofDentistryandtostimulateexcitementamongteach-ersaroundtheirintellectualcontent.WhynowAmongthethreeareasonwhichfac-ultyperformanceistraditionallyjudgedteachingresearchandserv-iceprofessorsplacethegreatestvalueonteachingaccordingtoasurveycon-ductedbytheHigherEducationRe-searchInstituteattheUniversityofCaliforniaatLosAngelesduringthe2010-11academicyear.6Nonethelessfacultyreportedthattheyreceivelittlesupportinimprovinghowtheyteachandspendlesstimeinclassthaninthepast.6Thisisconsistentwiththeviewheldbyacademicswhoeducatefuturehealth-careproviderswhereexcellenceinteach-ingiscentraltothemissionofdentalandmedicalschoolsforexamplebutisoftenundervaluedandunder-supported.1BecauseofthescopeandscaleofchangesinthepresentageJADEintendstoinviteexpertsinhighereducationtofaceoffonthethornyissuesconfrontinghighereducationevenasitendeavorstofosterinterdisciplinaryandinterprofes-sionalcollaboration.ThisinauguralissueisamodelforthesortsoftopicsthatJADEintendstotackle.Inhisprovoca-tivecenterpiecearticletitledTheDen-talEducationBubbleAreWeReadyforaLEED-StyleRatingCharlesN.BertolamiusestheLEEDratingsystemasaprototypethatinhisownwordscouldbeadaptedtodentaleducationinordertogivedentalschoolapplicantsfacultymembersgovernmentalofficialsthemediaandthepublicamoreopenandhonestappraisalofwhatagivenWyJADEWynowMiiamr.robbisDDSmSidtPstcrextvPlnYuadyofDstgsdedtorsMaye.nothidgPDmPhcredtorlBordJournaloftheAcademyofDistinguishedEducators 4WinTereducationalprogramhastoofferandwhattheeducationalproductisreallyexpectedtobe.7Inhisco-gentlyarguedrejoinderAllanJ.Formicolaas-sertsthattheratingsystemproposedwillnotimprovetheprofessionbecausethecurrentac-creditingprocessdoestakeintocon-siderationdifferencesindentalschoolsmissionsandgoalsbutassuresthatallschoolsnewandestablishedmeetstan-dardsthatareacceptedbytheacademythepracticingcommunityandthelicens-ingcommunity.8FinallyRonaldBayerplaceshisem-phasisonwhatthestatehasadutytodotoassureequitableaccesstohealth-careservicestocreatejusthealthcaresystemsandtosecurethesocialcondi-tionsthatpromotehealthandlimitdis-easeanddisabilityandassertsthatacoremissionofdentaleducationintheUnitedStatesoughttobeunderstandingthesocialforcesthatmayfosterorim-pedethepathtodentaljustice.9WhatsianameEvenwithintheNYUAcademyofDistinguishedEducatorsthereiscontro-versyregardingitsname.Severalmem-bersrespondnegativelytoaperceivedauraofelitismwhentheAcademysgoalistobeacontinuallyevolvingdynamicorganizationthatwilleventuallyincludetheentirefacultyoftheNYUCollegeofDentistry.1Sotoowasconcernex-pressedoverthetitleofthejournalespe-ciallywhenthewordjadehascertainwelljadedmeaningsWhatfunthentodis-coverthishipdefinitionofjadebynewyorkgirl1995intheUrbanDictionarywebsiteJadsthsawsomamazgglwhosaawsomfdasshsalwaysthfohfdsshstcksupfowhatshb-lvssghtallthtmshsloyaltowhosloyaltohbutwllotbwalkdallovshtustsutlshhasaasoottooadblbsscodchacs.Shsabgdamaddtmdtomakhdamsaltyshsotafadtosayhowshflsshsvycagvymadadjustaall-oudcpsoadfd.10AtJADEweintendtodreambigdreamsandwearedeterminedtomakethemareality.Forusthismeanscreat-ingaforumwhereeducatorsarefreetoproposeboldtheoriesandarenotafraidofencounteringopposition.Itmeanssteppingawayfromtheformerparadigmofthelecturingmethodandconsideringinnovativeformsofinstructioninclud-ingaddressingcomplexdentalmedicalandsocialproblemsashealthcareteamsthatreflectreal-worldsituations.Anditmeansincorporatinginteractivetechno-logicaltoolsasadjunctstoface-to-faceengagementwithpeersandmentors.Finallyitmeansacknowledgingthatnoteverypedagogicalideaisgoingtomoti-vatestudentstolearnbutthatinordertodiscovertheonesthatwillitisneces-sarytoexplore.BecauseofthescopeandscaleofchangesinthepresentageJADEintendstoinviteexpertsinhighereducationtofaceoonthethornyissuesconfrontinghighereducationevenasitendeavorstofosterinter-disciplinaryandinterprofessionalcollaboration.ThisinauguralissueisamodelforthesortsoftopicsthatJADEintendstotackle.refeeces1.AcademyofDistinguishedEducatorschairpersondiscussesfutureplansfortheacademy.GlobalHealthNexus.201214195-96.2.NewYorkUniversity.GlobalnetworkuniversityInternet.2012cited2012Nov7.Availablefromhttpwww.nyu.edustudentsgraduatesglobal-network-university.html3.PublicLibraryofScience.LicenseInternet.2012cited2012Nov7.Availablefromhttpwww.plos.orgaboutopen-accesslicense4.InternationalCommitteeofMedicalJournalEdi-torsICMJE.Uniformrequirementsformanu-scriptssubmittedtobiomedicaljournalsstatementofpurposeInternet.2009cited2012Nov7.Availablefromhttpwww.icmje.orgsop_3how.html5.NewYorkUniversity.AboutNYUInternet.2012cited2012Nov7.Availablefromhttpwww.nyu.eduabout.html6.BerrettD.Facultyvalueteachingmostdoitleast.ChronHighEduc.2012LIX10A13.7.BertolamiCN.ThedentaleducationbubblearewereadyforaLEED-styleratingJADE.201311513.8.FormicolaAJ.Anargumentagainstadentalschoolrankingsystem.JADE.2013111420.9.BayerR.Thecoremissionofdentaleducation.JADE.2013112122.10.Newyorkgirl1995.DefinitionofjadeInternet.2012cited2012Nov7.Availablefromhttpwww.urbandictionary.comdefinephptermjade 20135LEEDCertifiedLEEDSilverLEEDGoldLEEDPlatinum.ThesearealldesignationsmadebytheU.S.GreenBuildingCouncilUSGBCwhenitestablishedaclearframeworkfortheenvironmentalsustainabilityofnewbuildingconstruction.LEEDisanacronymforLeadershipinEnergyandEnvironmentalDesign.Theterminologywillbefamiliartoanyonewhosbeeninvolvedinmajorbuildingprojectsonanyuniversitycampusinrecentyears.Theratingsreflecttherequirementsfordesignconstructionandoperationofhigh-performanceenviron-mentallysoundecologicallysustainablebuildings.WhatdoesthishavetodowithdentaleducationIbringuptheLEEDratingsys-temnottodiscussthephysicalconstructionofnewdentalschoolbuildingsratherImusingaLEED-styleratingsystemasamodelthatcouldbeadaptedtodentaleducationinordertogivedentalschoolapplicantsfacultymembersgovernmentalofficialsthemediaandthepublicamoreopenandhonestappraisalofwhatagiveneducationalprogramhastoofferandwhattheeducationalproductisreallyexpectedtobe.Thismakessensetomebecausedentalschoolshavenowdivergedsufficientlyfromeachotherintheirambitionstheireducationalphilosophiesandinthelearn-ingexperiencetheyofferstudentsbeyondtheminimumrequiredbyaccreditationstandardstoconfoundinterestedpartiesandobscuretheirsignificantdifferences.InfacttheAmericanDentalAssociationsCommissiononDentalAccreditationCODAstatementassuresthataccreditationcannotbeusedtodifferentiateamongdentalschoolsTpdtdtsdtdbytcssDtadttoptionalapprovedwithorwithoutreportingrequirements.Thatsit.Eventhepastpracticeofgivingdentalschoolscommendationsforgoodperformancehasnowbeendiscontinuedprobablybecausedentaldeanstalliedupcommendationsandusedthefinalnumberasapublicrelationstactictodistinguishtheirownschoolfromtherest.Increasinglythoughdifferentschoolshavediffer-entphilosophiesofferdifferenteducationsandyielddifferentoutcomes.CODAaccreditationdoesnttellusmuchbeyondthegraduatesbeingeligibleforlicensureinagivenjurisdiction.ThisisbecausetheCODAsys-temwasneverdesignedtolookathowdentalschoolsdifferfromeachotherbutrathertolookathowtheyarealikeinmeetinganagreed-uponcoreofminimumthedentALeduCAtionBuBBLeareWereaDYForaleeD-STYleraTingCarlsn.BrlamDDSDmdShrbtFxDnYucfDtstyMyproposalisnotintendedasareplacementfortheCODAaccreditationprocessbutratherasasupplementtoitforinterestedinstitutionsandindividuals.WecanthinkofCODAassimilartoacity-issuedpermittoconstructanewbuilding.CODAtherebyremainsfundamentalbutitisonlythebeginning. 6WinTerstandards.Whilethisisentirelyappropriateforanaccredita-tionsystemIwonderifapointhasbeenreachedwheremorethantheminimumrequirementsisneededPerhapsweshouldbethinkingaboutbuildingupontheCODAsystemthroughastrictlyvoluntaryLEED-stylesystemavailabletointeresteddentalschoolsinordertomaketheirspecificmissionsvisionsandvaluesmoretransparentandrelevanttothepublicinclud-ingtoprospectivestudents.AccordinglymyproposalisnotintendedasareplacementfortheCODAaccreditationprocessbutratherasasupplementtoitforinterestedinstitutionsandindividuals.WecanthinkofCODAassimilartoacity-issuedpermittoconstructanewbuilding.CODAtherebyremainsfundamentalbutitisonlythebeginning.APenchantforankingsThedesirebydentalschoolapplicantsforcomparativeinfor-mationisreflectedbytherankingsofdentalschoolsfoundonwebsitessuchashttpstudentdoctor.netorhttpdental-schools.findthebest.com.Theygrabwhateverdatatheycanbutnoneofthedataarebackedbyacredibleorresponsibleagencynorisparticipationvoluntaryfortheinstitutionsnamed.Weightisaccordedanygivenattributebasedontheinterestsandidiosyncrasiesofthepersonsmakinguptheranking.AgoodcaseinpointisthenowdiscontinuedU.S.NewsandWorldReportrank-ingofdentalschoolsthatwasformulatedonnothingmorethanaskingdentalschooladmin-istratorstorankallschoolsbasedontheirsubjectiveimpres-sionsofthefewschoolstheyactuallyknewaboutaswellasthemajorityofschoolsaboutwhichtheyknewpreciselynothing.Despitethesedefectshoweverperhapstheimpulseunderly-ingrankinglistsandthecountingupofcommendationsoughttobelistenedtoasanexpressionofalegitimateneed.MaybethepenchantforrankingsistellingussomethingimportantInsufficientcomparativeinformationisavailabletomakein-formedchoicesbypeoplewhoneedtoknow.Maybesomecrediblemethodisneededfordistinguishingamongaccreditedprogramsnotwitharankingbutwitharating.Maybeafewcategoriesofratingscertifiedsilvergoldplatinumorsome-thingsimilarwithwell-definedcriteriawouldofferapplicantsandthepublicmoreinformationthantheygetnowandmightgiveinstitutionsatangiblegoaltostrivefor.AratingsystemcoulddifferentiateprogramsthatofferaneducationfromthoseofferingtechnicaltrainingadistinctionaptlydescribedbyR.BruceDonoff1whostatedthathefa-voredshiftingthebalanceawayfromtrainingandtowardedu-cation.Donoffcontraststhequalitiesofhighereducationwiththoseofvocationaltrainingandarguespersuasivelythattheeducatormustusedifferentmethodsfromthoseofthetrainer.Educationencouragescriticalthoughtwhereastrain-ingcanbebasedonimitationorparroting.Recognizingthisdistinctionmightbeimportantbecausethedifferencesbetweenaccrediteddentaleducationprogramsandthephilosophiesthatinspirethemarebecomingasgreattodayastheywereintheearly20thcentury.SomeDDSDMDprogramsseemtobemovingtowardaprofit-generatingvocationaltrainingmodelwhileothersareemphasizingandinvestingintheirstatusasmaturecompo-nentsofthenationsfinestresearchuniversities.Someseethemselvesasaddressingtheincreasinglyapparentandprob-lematicdisparityinaccesstodentalcarebetweentherichandthepoorwhereasothersremainorientedtowardthetraditionaluniversityvaluesofresearchteachingandservice.Itshardtoimaginethatthedivergencenowtakingplacewouldbecompletelyirrelevanttothestu-dentsinvolvedortothepublic.Anextremelyvariableandin-consistenteducationalsettingsometimesdrivenbypropri-etarymotivesiswhatnecessi-tatedthelandmarkGiesReportof1926withitsattendantcommitmenttomakingeducationinthebiomedicalsciencesascentraltothestudyofdentistryasitwastomedicine.There-sultwasthatinnumerablenon-university-affiliatedproprietarydentalcollegesclosed.TheseclosedcollegeshadnameslikeBarnesDentalCollegeCentralCollegeofDentistryGerman-AmericanDentalCol-legeHomeopathicHospitalCollegeInterstateDentalCollegeSanFranciscoDentalCollegeSoutheasternDentalUniversityNationalMedicalUniversityofIllinoisandmanymore.TheywouldbereplacedbyanothercategoryofinstitutionwhosemembershadnameslikeHarvardUniversityColumbiaUniversitytheUniversityofPennsylvaniatheUniversityofMichiganandtheUniversityofCalifornia.Notallprofessionsfollowedthesamepattern.Forinstanceindependentchiro-practicandosteopathicschoolshavemaintainedamodelPerhapsweshouldbethinkingaboutbuildingupontheCODAsystemthroughastrictlyvoluntaryLEED-stylesystemavailabletointeresteddentalschoolsinordertomaketheirspecicmissionsvisionsandvaluesmoretransparentandrelevanttothepublicincludingtoprospectivestudents. 20137whoseinstitutionalnamescontinuetoevoketheproprietaryflavorofthedentalschoolsofthe1890sasdoincidentallythedentalschoolsnowbeingspunoffbythemajorosteopathicchains.Thisisnotgoodorbadbutitdoesreflectaspirationsdifferentfromthoseofthefoundersofmoderndentaleduca-tionwhoaudaciouslyaimedtoincorporatetheirfieldintowhatwouldsubsequentlyberecognizedastheCarnegieclassificationshighestcate-goryofresearchuniversity.Fordentistrytheresulthasbeenanenormousincreaseinthequalityanduniformityoftheeducationalproductac-companiedbythetransfor-mationofatradeintoaprofession.Inthe1950swhenthegraduatesofthesemajorinstitutionsstronglyendorsedthefluoridationofpublicwatersuppliesandtheuseoffluoridateddenti-fricebecominginthepub-licsmindthemostenthusiasticproponentsforputtingthemselvesoutofbusinessbyeliminatingthediseasetheywereeducatedtotreatthepublicsconfidenceindentistryasaprofessionincreasedimmenselyasdiddentistrysprestigeasalearnedendeavor.Alasnothingisforever.Fearingtheearlysignsofarever-siontoanolderandadiscreditedmodelofdentaleducationDr.PeterPolverinideanoftheSchoolofDentistryattheUniversityofMichigancalledameetingofabouthalfofthenationsdentalschooldeansinMay2010inAnnArborMichigan.Dr.Polverinis2concerncenteredontheemergenceofatieredsystemofdentaleducationresultingfromtheopeningoverthepastdecadeofanumberofdentalschoolswithoutaclearresearchmission.Hepointedoutthatresearch-intensiveuniversitiesdemandthatalloftheirschoolsandcollegesin-cludingdentalschoolsdemonstratecertainstandardsofexcel-lenceintermsofresearchanddiscovery.Indeedsuchschoolsarelookeduponasfullpartnerswithinthemissionoftheuni-versity.WhataretheoptionsfordentaleducationAsmoreschoolsemergethatdonotalignwiththemissionoftheresearchuni-versitydoesdentistryabandonitshard-wonstatuswithinthemainstreamofhighereducationnewerschoolsprosperingfinanciallywhileembracingthelookofacommunitycollegeandthefeelofaproprietaryenterpriseNottomentionthequestionposedbyDr.PolveriniWhoisgoingtoleadtheprofessionintothefutureifallwearedoingistrainingdentiststobetechni-callycompetent2Furthermoreadichotomyexistsnotonlybetweennewlyfoundeddentalschoolsandlong-establishedonesbutalsobetweenthedivergingeduca-tionalprogramsofschoolsthathavebeenaroundforyears.Manysuchschoolsexistwithinresearch-intensiveuniversitiesbutwithoutem-bracingtheresearchmissionoftheparentuniversity.Itwasthismisalignmentbe-tweenthemissionoftheuni-versityandtheactualifsilentmissionofthedentalschoolthatplayedabigpartintheepidemicofdentalschoolclosingsthatbeganinthe1980s.PolveriniscommentaryontheoutcomeoftheAnnArbormeetingstatesthekeyfactsfordentalschoolsbothnewandold2nowforthersttimeierlyceturytheimpor-tceofthebiomediclsciecesithedetlschoolcurriculumdreserchithebsicbiologyoforlstructuredthepthologyoforl-fcildiseseisbeigchllegedbythisewdirectioidetleduc-tiowhichisbsedothepremisethtshiftfromemphsisoreserchtotechigisrequiredtoprovidemorecreforuderservedpopultios.Ficillydriveresourceissueslsoplyroleiexpliigtheriseoftheo-reserch-orieteddetlschools.adetleductiomgemetmodelthtreducesopertigcostsbycotrctigoutthebsicsciecesto 8WinTerao-sdtalbascsccfacultyadshftgsttutoalpotsfomthtadtoalclcalduca-tosachadpattcamodltoamphassoclcalducatoadcacatallyappaattactv.Butocyoumotgagthsposbltyofbascadtaslatoalsachtosomolsyousstallyloscotolovthfutuofthpofsso.TheobjectiveoftheAnnArbormeetingwastopreventsuchachangefromoccurringinthefoundationalpremiseofdentaleducation.WhileIagreefullywiththemotivesoftheAnnArbormeetingIbelievethechangehasalreadytakenplaceatiereddentaleducationhasbecomeareality.Thispaperadvo-catesbeingmoretransparentaboutitagoalthatacriteria-drivenratingsystemcouldhelptoachieve.Ifadentaleducationmanagementmodelthatreducesoperatingcostsbycontractingoutthebasicsciencestoanon-residentialbasicsci-encefacultyandshiftinginstitutionalprioritiesfromthetradi-tionalclinicaleducationresearchandpatientcaremodeltoanemphasisonclinicaleducationhastakenplaceshouldnteverybodyknowaboutitNoteveryschoolcanbecategorizedasresearch-intensiveandmoreimportantmaybethatsfine.Itsachoice.Aratingsystemcouldmakethechoicesthathavealreadyoccurredmoretransparenttoeveryone.WhyemphasizrsachMaybeImplacingtoomuchemphasisonthesignificanceofresearchindentaleducationasawayofclassifyingorratingdentalschools.Afterallresearchissupposedtobeaboutdis-coveringnewtreatmentscuresanddiagnosticmethodsnotnecessarilyaboutteachingstudents.Isntthiswhyevenresearch-intensiveuniversitiesdrawadistinctionwithintheirthreefoldmissionofresearchteachingandserviceIndeedwhetherneworolddentalschoolstodaylegitimatelydifferamongthemselvesontheim-portanceofresearchandscholarship.Schoolsthatgivelipserv-icetotheimportanceofresearchmaynotinfactactinaccordancewithprofessedbeliefsnotevenwhentheirparentuniversitiesgenuinelydohaveresearchasanimportantmission.ButresearchwithinaneducationalinstitutionisnotonlyaboutnewdiscoveriesitsalsoaboutaprevailingenvironmentcongenialtointellectualactivityThekindsoffacultymembersaresearch-intensiveinstitutionattractsandtheinfluencesthosekindsoffacultyexertontheeducationofdentalstudentsareverydifferentfromasettinginwhichfacultymembersarecom-pletelyunengagedinresearch.HenryRosovskysclassicbookTheUniversityAnOwnersManual3arguesthatitmakesadifferencewhenthepersonbehindthepodiumisalsotheper-sonwhowrotethetextbookthatuniversity-levelteachingisdifficultwithoutthenewideasandinspirationprovidedbyre-search.Acombinationofteachingandresearchispartoftheuniversityfacultyidentity.Theuniversityprofessorisnotateacherwhoisexpectedtoconfinehim-orherselftothetrans-missionofreceivedknowledgetogenerationsofstudents.Heorsheisassumedtobeaproducerofnewknowledgewhotransmitsstate-of-theartknowledgetostudentsatalllevels.Similarargumentscanbemadeaboutwhetheraschoolsfac-ultywillincludetenuredfull-timeacademicsandbasicscien-tistsorwhetheritwillconsistexclusivelyofsuperannuateddentistswhohaveleftprivatepracticeandarewillingtounder-takeapart-timeorvoluntaryteachingpositionasaretirementdiversionDoesadentalschoolintegratedwithinamajorresearchuni-versityoffersomethingdifferentdoesitcontributesomethingmoretotheeducationofstudentsIfsohowissuchadiffer-enceacknowledgedRosovsky3reflectsontheimpactofresearchuniversitiesinsocietyatlarge.ThereareslightlyoverthreethousandinstitutionsofhighereducationintheUnitedStates.Atthetopinhisviewarethebestresearchuniversitiesnumberingabout50bothpublicandprivate.Heconsiderstheseinstitutionstobethecut-tingedgeofournationallifeofthemind.Theydeterminetheintellectualagendaofhighereducation.Theysetthetrends.3Inthiswaytheyalsoestab-lishthepriorities.Isthissome-thingweindentaleducationarewillingtogiveupHowwillitbedecidedwhohasaseatatthetableofhighereducationlead-ershipifalldentalschoolsareconsideredequivalentinnamebutnotinsubstanceHowhaveorhavenotthenationsden-talschoolsbecomedistributedamongtheseeliteresearchuni-versitiesortoputitanotherwayamongthenationsfinestuniversitieshowmanyhaveoptedtohavedentalschoolsAhighlevelofsuccessinincorporatingdentalschoolsintoresearchuniversitiesofthehigheststaturecouldbeoneindexAhighlevelofsuccessinincorporatingdentalschoolsintoresearchuniversitiesofthehigheststaturecouldbeoneindexofdentistryssuccessoverthepastcenturyinreinventingitselfnotonlyasadisciplineandvocationbutasalearnedprofession. 20139ofdentistryssuccessoverthepastcenturyinreinventingitselfnotonlyasadisciplineandvocationbutasalearnedprofes-sion.Answeringthisquestionrequiresknowingwhichuniversi-tiesqualifyasthenationsbest.Rosovskyneveractuallyenumeratedhislistofthetop50or100USuniversities.Buthedidmakeclearthekindsofplaceshehadinminduniversitiesthatleadtheworldinbasicscienceresearchprovideasignifi-cantshareofthemostcompetitivegraduateprogramsandaregener-allyatthecuttingedgeSuchuni-versitiesarecompetitive.Institutionsofthesameclasscompeteforfac-ultyresearchfundsstudentspublicattentionandmuchelse.RosovskysaysthatattopAmericanuniversi-tiesfacultiesareassembledlargelyonthebasisofindividualqualitywithouttheconstraintofconsideringwheretheyreceivedtheireducation.Qualityandcompetitivenessdictate.Atsuchplacestherearenoreserva-tionsaboutthebeneficialeffectsofcompetitionseeingitasastrategytopreventcomplacencyorindolenceandpromptingthedriveforexcel-lenceandchange.Suchuniversitiesassumethatthequalityoftheirfacultyplaysthesinglemostimportantroleinmaintain-ingreputationandposition.Thebestfacultyattractsthefineststudentsproducesthehighest-qualityresearchandgainsthemostoutsidesupport.3Fewwouldarguethatdentistryshouldnothaveaseatatthetablebutincreasinglydentaleducationinstitutionsarenotwillingtocommitthem-selvesfinanciallyorpsychologicallytomakingthishappen.InfactthetrendsthatimpelledtheconveningoftheAnnArbormeetingsuggestthatdentalschoolsareworkingtoreversethegainsofthelastcentury.ASlipperySlopeContemplatethisstatisticBetween1982and2000sevendentalschoolsclosednoneofthemhavingasignificantre-searchportfolio.Forgetthedentalschoolsthemselves.Lookinsteadattheparentuniversitiesofthedentalschoolsthatclosed.Fiveofthesevenparentuniversitiesarethekindsofinstitutionsthattodayhaveinaggregatealmostabilliondollarsofresearchfundingandqualifyasresearch-intensiveuniversities.Lackingasignificantresearchportfoliothoseparticulardentalschoolsdidntreallyfitwithintheparentuniversitiesthathousedthem.Nowlookattheparentuniversitiesofthefirstfivedentalschoolsthathaveopenedsince2000TheNIHresearchfund-ingoftheparentuniversitiesamountstoonly3.5million.Rememberweretalkingabouttheparentuniversitiesnotthedentalschools.ThismeansthattheaggregateNIHfundingofthesefiveparentuniversitiesequatestoaboutthesameamountastheresearchfundingofthesingledentalschoolranking21stamongdentalschoolsinNIDCRfundingtoday.Whatthismeansisthattheparentuniversitiesoftheseinstitutionsthemselvesdonotseeresearchaspartoftheirmissionwillnotattractresearch-orientedfacultyandthatthedentalschoolstheyhoststate-mentstothecontrarynotwithstand-ingwillhavelittleorientationtowardresearch.Thishastomeansomethingabouttheenvironmentwithinwhichstudentsintheseschoolswillbeeducatedyetwepretendthatalldentalschoolsarethesamebecausetheyareallaccredited.ShouldanyonecareItsnotformetosaybutitshouldatleastbeknown.Somesystemformakingsuchadifferencemoretransparentwouldbeamorehonestwaytogo.Ratingsinhighereducationarenothingnewwithperhapsthemostwell-knownbeingtheCarnegieClassificationofInsti-tutionsofHigherEducation.4TheinterestingthingisthatitappearsthatdentalschoolsarenolongerbeingestablishedwithinthehighestCarnegieclassificationofdoctorate-grant-inguniversitieswithveryhighresearchactivityRUVHorhighresearchactivityRUH.Todaywithonepossibleex-ceptionnewdentalschoolsaremainlyassociatedwithparentuniversitiesidentifiedasspecialfocusinstitutions.ThisCarnegiecategoryincludestheologicalseminariesBiblecol-legesotherfaith-relatedinstitutionsfreestandingmedicalschoolsandmedicalcentersotherhealthprofessionsschoolsandotherspecial-focusinstitutions.Thisisnotnecessarilyabadthingbutitmaysignalashiftinthepublicsperceptionofthedentalprofessionandmorethanthatitmaypredict 10WinTersomethingaboutdentistrysstatureinthefuture.Idothinkthathavingdentalschoolsatthemostprestigiousuniversitiesinthecountryhasmadeadifferenceinhowthedentalprofes-sionhasbeenviewedasawhole.Idoworrythattherichnessanddiversityofhealthscienceseducationwithinamajorre-searchuniversityisatriskofbeinglost.elmnsofarainSysmgoinByonrsachResearchofcourseisonlypartofthestory.Forinstanceconsiderthoseschoolsthatsacrificearesearchagendainthenameofeducatingdentiststohelpredressthedisparityinac-cesstocarebetweentheaffluentandtheindigent.DosuchschoolsofferamarkedlyreducedtuitionandoragreatlyenhancedfinancialaidpackageDothegraduatesofsuchschoolsbearsignificantlylowerdebtburdensmakingitmorelikelythattheycanenterthepublicservicesec-torIfthisisnotthecaseistheresomelogicalresolutiontotheinconsistencybetweenastatedmissiontoservethebroaderpublichealthwhileatthesametimeburdeningstu-dentswithadebtlevelthatal-mostassurestraditionalprivatepracticeastheonlyfinanciallyviableoptionavailabletothemFromtheinstitutionsperspectivedoeschargingahightu-itionwhileatthesametimenotinvestinginfacultypreclinicalandclinicalfacilitiesandresearchprogramsaccomplishany-thingbeyondgeneratingsignificantfinancialsurplusesfortheownersofthedentalschoolTheapproachtakenbysomeofthenewerschoolsisnottheonlyoneworthdiscussionConsiderlong-establishedpublicdentalschoolsofferingamodesttuitionforin-stateresidents.Aretheresidentsinthosestatesthataresubsidizingtheeduca-tionofdentalstudentsgettingtheirmoneysworthDotu-ition-subsidizedgraduatesofpublicdentalschoolsgiveasufficientreturnonthestatesinvestmentinthemForinstanceabsentthedebtburdencarriedbyprivatedentalschoolgradu-atesdodentistswhograduatefrompublicdentalschoolschargetheirpatientslessonaverageAretheymorelikelytoparticipateinMedicaidreimbursementprogramsAretheymorelikelytoacceptpatientswhoareonpublicassistanceorarecompletelyindigentAretheymorelikelytopracticeinun-derservedareasAregraduateswhobenefitedfromheavilystate-subsidizededucationsevenlikelytoremaininthestatethatpaidforabigchunkoftheireducationSuchacritiquecanbetailoredtoanydentalschoolArethehigh-tuitionresearch-intensivedentalschoolsreallydeliveringonwhatthestudentsarepayingforAsimportantasIthinkaneducationcoloredbyresearchmaybeonetaughtbythehigh-est-qualityfacultyatthebestuniversitiesmaybethatsnotwhatalotofstudentsarereallyinterestedin.Maybethebeststudentsgotothecheapestschoolsbecausetheiracademicrecordsarethemostcompetitiveandtheyhavethechoiceofattendinganydentalschooltheywant.Maybewhatsleftarethelessacademicallygiftedwhoaretheleastlikelytobenefitfromthekindofeducationafirst-ratefac-ultyandafirst-rateuniversitycanoffer.Ifahigh-tuitionresearch-intensivedentalschoolreallyisofferingabettereducationalproductitoughttobeabletoproveit.Itispreciselybecauseeachoftheseviewpointsiscrediblydefen-siblethatIthinkaratingsystemisagoodidea.Leteveryoneknowexactlywhattheyregettinginto.thdiculisofdvisinarainSysmInevitablyaratingsystemisvalues-driven.Forinstancethead-containingwebsitehttpdental-schools.findthebest.comoffersrankingsbasedonwhatitclaimsareunbiaseddata-drivencomparisons.Howeverthedatahastobeevaluatedbysomeoneandwhoeverthatanonymouspersonisheorshewillhaveavaluesystemthatdecideswhatwillbeincludedwhatwillbeexcludedandwhattheweightaccordedeachcate-gorywillbe.TherankingisbasedontheschoolsprogramsandstatisticsincludingaverageDATscoresmeanGPAadmit-tedclasssizeNIDCRfundingandmore.ThewebsitestatesthatFindTheBestgathersratingsfromthemostrespectedex-pertsineachcategory.WhoexactlyaretheseexpertsandhowdothechoseninputdatamakeadifferenceintheeventualeducationaloutcomethethingwerereallyinterestedinIwonderwhymeancollegeGPADATscorestuitionlocation 201311percentageoftheapplicantpooladmittedorclasssizewouldbefactoredintoaratingsystem.Theseareallthingsthathavesomeinteresttoanapplicantseekingadmissiontoaparticularschoolbutdistillingsuchdataintoarankingdoesntmakemuchsensebecausethedataaresoeasilyavailabletoapplicantsthroughpublicsources.Amuchmoreimportantandimpressivemetricforaratingsystemmightbeonebasedonwhatadentalschoolactuallyachieveswiththestudentstheydoadmit.Whenexcellentstudentsenteraschoolandequallyexcellentstudentsexititfouryearslateritdoesntreallysaymuchabouttheeducationalprogramwhethertransformativechangeat-tributablespecificallytotheschoolitsprogramsanditsfac-ultyisarealisticexpectation.Goodstudentsinabadenvironmenttypicallymakethebestofitandstilllearnalotevenwhenthesystemineffectworksagainstthem.Ontheotherhandwhenstudentswithmarginalbackgroundsgoontobrilliantcareersitsayssomethingabouttheeducationalprogramitselfasopposedtothequalificationsthestudentscameinwith.RatherthanfocusonadmissionnumberseasythoughtheyaretosecureitmightmakemoresensetolookatthepassrateonPartIandPartIIoftheNationalBoardExaminationandonregionallicensingexaminations.ThisalldistillstoasimplefactData-drivenrankingsarenotthatusefulwhentheinstitutionsbeingrankedarenotvoluntaryparticipantsintheratingsystembecausethequantityandqualityofdataareoftenonlywhateverispubliclyavailable.Theelementsofaratingsystemwouldneedtogofarbeyondthiswhattheed-ucationalprogramactuallypro-ducesespeciallyintermsofoutcomemeasuresthatarenotpubliclyevident.Idontthinkitwouldtakelongforwell-inten-tionededucatorspractitionersahighlyqualifiedthinktanksuchastheSantaFeGroupandmembersofthepublictode-finetheappropriateparametersparametersbasedonoutputsnotinputs.Itwouldrequirethatthevoluntarilyparticipatinginstitutionbewillingtoinvesttimemoneyandeffortinsecur-ingfollow-updatareflectingtherealimpactofitseducationalprograms.ExampleswerementionedearlierSomeschoolspurporttoeducatepublicservice-orientedgraduateswhowilldisproportionatelyseekemployedpositionsinthepublicsectorratherthaninhigher-incomeprivatepractice.DoessuchaschoolcrediblydeliveronthatclaimoverthelongtermSuchinformationcouldbefac-toredintoarating.Schoolsacceptingmajorsubsidiesfromstategovernmentscouldaccountforadisproportionatebenefittothecitizensofthestatethatpaidthebillifsuchabenefitactuallyexists.High-tuitionschoolsthatclaimoutstandingfacultyandstrongresearchprogramsoughttobeabletodifferentiatetheperformanceoftheirstudentsonobjectiveexternalmeasuresofachievementincomparisontootherschools.Beyondthenecessityofparticipationbytheschoolbeingratedprotractedpreparationtimewouldberequiredaswouldasitevisitbyaknowledgeablereviewteam.Thiswouldbeaworthwhileinvestmentforaninstitutioniftheresaplatinumratingintheoffing.Noneofthisiseasybutitsimportantandworthwhile.AswiththeU.S.GreenBuildingCouncilsLEEDratingthefoundingpremisehastobestatedunambiguouslysothatinsti-tutionscanknowthecriteriatheyneedtoaimforineachrat-ingcategory.AswiththeLEEDsystemitwouldbeimportantforaninstitutiontotargettheratingitisseekingthatisnoteveryinstitutionshouldaimforplatinumandfailingthatbegrantedgoldorsilverasaconsolationprize.Criteriaforcate-gorieswouldneedtobedefinedinsufficientdetailsothataninstitu-tioncanprettymuchknowthatitqualifiesaheadoftime.Ofcoursethedesignationsplatinumgoldsilverandcertifieddoconveyanimplicitstatementofqualitybuttheyareallgood.Thedesignationsforaratingsystemcouldbenon-hierarchicalresemblingtheCarnegieclassificationsmentionedearlierratherthantheLEED-stylerating.isethcsaLgtmatoutcmJustabouteverybodyknowsthatthedentalprofessionhasgottenitselfinaterriblefix.Thedeathofa12-year-oldfromdentaldiseasebroughttopublicattentionanegregiousdispar-ityinaccesstodentalcarebetweenrichandpoor.Todaywhenthedentalprofessionismentionedinthemediathenewsistoooftenbadarealpublicrelationsdisaster.Idobelievethatwhenconsideringdentistsasawholeasignificantsegmentofthepopulationthinksthatdentistsaremoreinterestedintheir 12WinTerownfinancialwell-beingthaninthehealthofthepublic.Thisistruenotonlyfordentistsbutforalmostanyoneinanyprofession.5EventheAmericanDentalAssociationADAhassome-timesbeenseenasmuchanadvocacygroupfordentistsasforthepublic.Neverthelessexcellentandtrustingrelationshipscontinuetobelivedday-by-daybetweenpatientsandtheirowndentists.Butthenegativeperceptionofdentistryorganization-allyisleadingtolegislativeinitiativestoimproveaccessbasedonthebeliefthatdentistscannotbetrustedtohelpthoseinneedwithoutthecoercivehandofthestate.Thusentirelynewcategoriesofdentistsarebeingformulateddentalthera-piststhatmovepasttheAmericanDentalAssociationandtheexistingdentalprofessionasawhole.Willthisnewsecond-arytierofdentistsactuallyimproveaccesstocareIdoubtitespeciallyaslower-paiddentist-therapistsmakefullycorporatizeddentalcaremoreprofitabletocorporationsthathithertohavebeenunabletoenterthismarketplacesuccess-fully.Butmypointhereisthatmaybedentalschoolshavetobearsomeshareoftheblamefortheaccess-to-careproblemifviewedasanethicalissue.HavewelostsightoftheeleemosynaryresponsibilityofeveryprofessionalpersonDentistsdenyingcaretopa-tientsinneedordecliningtoparticipateinpublicassistancereimbursementprogramsmightbeinterpretedasafail-inginthewayweteachethics.MaybearatingsystemofthetypeIamproposingcouldin-corporatenotwhatistaughtinourethicscurriculaasimpleinputbutratherhoweffectivelywhatweteachactuallyplaysoutindentalpracticeespeciallyforpatientsunabletopay.Againsuchaschemawouldrequirethattheratedinstitutionparticipateestablishsystemstotracksuchinformationandin-centivizetheirowngraduatestobeforthcoming.Whethercreationofnewcategoriesofdentistswillorwillnotimproveaccesstocareisbeyondthescopeofthispaper.Ibringupthematteronlytounderscoretheimportanceofarat-ingsystemforschoolsthatconfertheDDSorDMDdegree.Doctoral-grantinginstitutionswillneedtodifferentiatethem-selvesfromnewdentist-therapyschoolsbecausethepublicisnotgoingtomakesuchfinedistinctionsdespitesignificantdif-ferencesinthecomprehensivenessofeducation.ThispointresonatedpowerfullyformeinastatementmadeinaPBSdocumentaryFrontlinebroadcastonJune262012.AnewlytrainedMinnesotadentaltherapistspeakingonbehalfofanewlycreateddisciplinearguedconfidentlyWatadtotlvlofadtst.howimtaugttodoallgowimtaugttodoaootcaaloababytootowimtaugttoxtactababytootsdtcaltottypofducatodtstscv.iamtadtotatlvl.imjusttadfwtgstaadtststadtodoidotkowwyayowouldwattoopposavywll-tadpofssoaltatgsomowootwswouldotgttatd.TheopeningstatementisthemostworrisomeWearetrainedtothelevelofadentist.ButisthisreallytrueThemostdangerouspeoplearethosewhodontknowwhattheydontknow.Thetherapististalkingaboutaspecificnumberofverylimitedtechnicalproce-duresbutwhataboutthecom-plicationsfromthoseproceduresItechoesthedis-tinctionDonoffmakeswhentalkingaboutthedifferencebe-tweenreceivinganeducationversusreceivingtrainingorpar-roting.Thetherapistsself-de-scriptionasaverywell-trainedprofessionalispreciselythepoint.WhostosayWhoisim-partialenoughtopreventself-interestfromintrudingintotheequationSubsequentlyinthebroadcastthepresidentoftheAmericanDentalAssociationexpressedtheviewthatOurconcernistheideaofalesser-trainedindividualdoingsurgicalprocedures.Itseemsaveryreasonableconcernhoweverthosewiththehighestqualificationsasexpertsareincreasinglybeingdelegitimizedbecausetheyareseenashavingavestedinterestinaparticularself-servingoutcome.Thatsocietyhasgottentothepointthatithaslostitstrustinitsownexpertsistragic5andreminiscentofLivysfirst-centurylamentthatwecanendureneitherourvicesnortheircure.6Maybeamoreaptanalogywouldbethatwecanen-dureneitherourproblemsnortheirsolutions. 201313thBubblthMakfodnalSvicsvs.hMakfodnaleucaionAkeypointmadebyPolveriniattheAnnArborDentalDeansForum2wasthatamotivationforthefoundingofnewdentalschoolsisthatashiftfromanemphasisonre-searchtoteachingisrequiredtoprovidemorecareforunder-servedpopulations.Itisimportantfordentaleducatorstounderstandthattherearetwoseparatebutinterrelatedmarkets.Oneisthemarketfordentalservicesthatisthepublicsde-mandfordirectdentalcare.Atthemomentthismarketisproblematicbecausegiventhesupplyofdentistsandthede-mandforservicessomepeoplearebeingleftoutthosewhocantpayandthereforeareunableeventoenterthemarketforservices.Publichealthdentiststhegovernmentandthemediaadvocateforsuchindividualstobecaredforoutsidethemarketsystem.Butthedentalservicesmarketisnotreallythemarketthatthenewerdentalschoolsareentering.Rathertheyareen-teringthemarketofpeopleseekingadentaleducation.Overthelongtermitmaybetruethatasthesupplyofdentistsin-creasesthecostofservicescoulddeclineandthepublicsin-terestwouldbeserved.Butmarketsarecomplexandthewaythemarketfordentalservicesandthemarketfordentaleduca-tionarerelatedmaynotconformtoexpectations.Aslongastherearemorepeopleseekingadmissiontodentalschoolthanthereareavailableseatsthemarketfordentaleducationcanbeveryprofitable.Theproblemisthatthetuitionandfeestruc-tureofnewschoolsisveryhighthusthegraduatesoftheseschoolsarenotlikelytobeinapositiontoprovidefortheneedsoftheunderservedwhorequireservicesoutsidetheex-istingmarketsystem.Inrealitynewdentistsarebeingaddedforthosepatientswhocanalreadypayforcareandforwhomtheresnotmuchofashortageofdentalservices.Addtothistheemergenceofdentaltherapistswhoovertimemayradicallychangethemarketfordentalservices.Ifarelationshipemergesbetweendentistsanddentaltherapiststhatiscomparabletotheonethatnowexistsbetweendentistsanddentalhygienistsitcouldmakedentalpracticeevenmoreprofitable.Alternativelyifdentaltherapistsbecomethebasisforafullycorporatizedmodelofdentalcareashashappenedinpharmacywiththelargechainsitsmoredifficulttoguesswhattheimpactonindependentdentalpracticewillbe.Itsnoexaggerationtosaythattodaysdentalstudentsarereallyspeculatorswillingtopayahighpriceforaneducationthatmayormaynotyieldthereturnontheirinvestmentthattheyexpect.Shouldthebubbleburstfordentaleducationevi-dencedbyasmallernumberofapplicantsthanavailableposi-tionsschoolswillneedtocompeteforstudentsmoreintensely.Drivenstrictlybyeconomicsthemostsuccessfulschoolswillbethosethatofferthefewestserviceshavethelowestexpensesatthehighestpossibletuition.Underthosecircumstancesallthingsbeingequalthemostsuccessfulandsustainableschoolswillbethenewestoneswiththemostrobustfinancialplans.Butmaybeallthingsarenotequal.Maybesomeschoolswillofferservicesthatwillcontinuetobevaluedbyapplicantsbeyondacquiringbasictechnicalskillsleadingtodentallicen-sure.Perhapssomeapplicantswillseethedifferentiatingvalueofaneducationthatconformstothehigheststandardsofthebestuniversities.Maybethosecontemplatingspecializationwillgravitatetothoseplacestheythinkwillhelpthemgainaccesstothebestpostgraduateprograms.ImnotreallysurethatthisistruehoweverIdothinkthataratingsystemofthesortIamproposingcouldbeastepintherightdirection.ThepurposeoftheAnnArborDentalDeansForumwastoframeawayofleadingtheprofessionintothefuture.Quitepossiblythehistoricalmomentforthatopportunityhadpassedbeforetheforumevertookplace.Theworryatthattimewasthatwewereonthevergeofmakingadangerousmistakeaboutthestandingofthedentalprofessiongoingforwardandthatwewillbegintolookmorelikeatradethanaprofes-sionaposturethatjeopardizesthelong-termprestigeandprogressofthedentalprofession.3Ibelievethatwearebe-yondthatpoint.Theleastwecandoistobehonestaboutit.Aratingsystemmighthelpusdoso.rfncs1.DonoffRB.CommentaryonBertolamiarticle.JDentEduc.2001658739-741.2.PolveriniP.TheAnnArborDentalDeansForumcraftingaresponsetotheemergingtieredsystemofdentaleducation.GlobalHealthNexus.201012224-27.3.RosovskyH.Theuniversityanownersmanual.NewYorkNorton1990.4.TheCarnegieFoundationfortheAdvancementofTeaching.TheCarnegieclassificationofinstitutionsofhighereducationInternet.Availablefromhttpclassifications.carnegiefoundation.org5.YankelovichD.Profitwithhonorthenewstageofmarketcapitalism.NewHavenCTYaleUniversityPress2006.6.Livy.Aburbecondita.FosterBOtranslatorGooldGPeditor.LoebClassi-calLibrary.CambridgeMAHarvard1919reprinted1978. CharlesBertolamisessayTheDen-talEducationBubbleAreWeReadyforaLEED-StyleRatingraisesmyriadquestionsfarbeyondtheusefulnessofdevelopingasystemtoratedentalschoolsasheproposes.Inordertosup-portthenotionofaratingsystemhedescribesthecurrentandrecurringdilemmadentaleducationhasfacedandthatonceagainhasresurfaced.1Namelywhileitisgenerallyrecog-nizedthatthetypeofeducationstudentsreceiveshapestheprofessionthetensionbetweenthesettingofdentalschoolsinthenationshighereducationsystemandthedualemphasesonthetechnicaltrain-ingrequiredtopracticedentistryandonthebiomedicalsciencesnecessarytoedu-catealearnedpractitionerhasneverbeenfullyresolved.Overthepastfiveyearsthisissuehasresurfacedduetotheopeningof10newdentalschoolsmostofwhicharelocatedonosteopathicmedicalcampuses.Berto-lamisuggeststhattheseschoolsareinferiorandfearsthattheywillleadtoadeclineindentistrysprofessionalreputation.ThiscommentarywillfocusontwounderlyingrelatedissuesraisedinBerto-lamisessay1thevisionfordentaleducationand2theresearchmissionandtheinstitutionalsettingfordentalschools.Theinterrelationofthesetwoissuesandtheirimpactonthedentalprofessionwillbediscussed.theVisinrdenalSchlsrmgiesonwarThevisionfordentaleducationduringthefirstandseconddecadesofthe20thcenturywasnotclear.WilliamGiesaprofessorofbiochemistryatColumbiaUniversitywaschosenbytheCarnegieFoundationtoassisttheprofessioninstandardizingtheeducationnecessarytobecomeadentist.TheFoundationwaswellawarethatwhenGiesbeganhisfive-yearstudyofdentalschoolsin1921itwasnotthenclearwhetherdentistryoughttobecomeaspecialtyofthecon-ventionalmedicalpracticeorwhetheritshouldremainafieldofpracticeforaseparatebodyofpractitioners.ThegeneralopinionatthetimecouldbesummarizedasfollowsBecauseofthemechanicalrequirementsmadeuponthepractitionerdentistrywasamechanicalartofrestorationandnotabranchofmedicine.HoweverDentalEducationintheUnitedStatesandCanadaAReporttotheCarnegieFoun-dationfortheAdvancementofTeachingwhichisbetterknownastheGiesRe-portpublishedin1926concludedthatthepracticeofdentistryshouldbeahealthserviceofequalrecognitionwithotherspecialtiesofmedicinealthoughitshouldremainaseparateprofessionfrommedicine.ThetypeofcurriculumrequiredforthestudyofdentistrywasdescribedinthereportasfollowsThecoursesshouldbeequalinqualitytothoseinthecorrespondingsubjectsintheundergraduatecurriculuminmedicine.2TheGiesReportislargelycred-itedwithestablishingthefoundationaagtAainsAllanJ.frmiclaDDSmSDetscolbuvstycollgofDtlmdDtlShoolrkgSyst14WinTer fordentaleducationintheUnitedStatesandemphasizingtheneedforfull-timefacultywhoaredevotedtopedagogyforincludingaresearchagendaindentalschoolsandforrequiringtwoyearsofprerequisitecollege-levelcourseworkforentry.RegardingthelatterGiesunder-stoodthataliberaleducationguardsagainsttherelativelynarrowinginflu-encesofaprofessionaltraining.andthatsuchpreparationfordentalschoolawakensandstimulatescuriosityandthespiritofenquiryandexpandsviewsandimprovesjudgment.WhiletheGiesReportwasveryclearindeclaringthetypeofprofessionaleducationrequiredforthepracticeofdentistrytherehasbeenalong-standingdebateabouttheemphasisonthebasicbiomedicalsciencecoursesandthetech-nicalclinicaltrainingneededtoeducatecompetentpractitioners.Forexamplein1941ORourkeandMiner3puttheargumentasfollowsAcommonaimofdentaleducationhasbeenthatofprovid-ingopportunitiesforthedevelopmentofskill.Thetraditionalbutfallaciousconceptofskillassomethingalmosten-tirelymanualiscommon.Motoractiv-itiesmustbeincidentalhowevertointellectualeffortifthedangersofrule-of-thumbmethodsandempiricismaretobeavoided.Inmorerecenttimesthe1995Insti-tuteofMedicineIOMReportDentalEducationattheCrossroadsChallengesandChangeagaindiscussedtheprosandconsofdentistryasamedicalspecialty.Whilethereportconcludedthatsuchadesignationwasnotpossibleforavarietyofpracticalreasonsiturgeddentistrytomoveclosertomedicinesothatprac-titionerswillbecomebetterpreparedtoworkaspartofahealthcareteaminamoreintegratedhealthcaresystem.Iturgedcurriculumreformcloserintegra-tionbetweenmedicalanddentaleduca-tionandayearofpost-graduateeducationforallgraduateswithanem-phasisongeneraldentistry.Thereportnotedthattoomanydentalschoolsanddentalfacultyareminimallyinvolvedinresearchandscholarshipandurgedschoolstoformulateaprogramoffac-ultyresearchandscholarlyactivitythatmeetsorexceedstheexpectationsoftheiruniversities.4The1995IOMReportalsonotedthehighdegreeofvariabilityincurriculumemphasisbasedoncoursehoursamongdentalschoolsasituationthatcontinuestoday.Whilethereisconsensusonthemajorblocksofsubjectmattere.g.basicsciencesclinicalsciencesandso-cialsciencesthereisnoconsensusontheemphasisamongthedifferentblockstobestudiedwiththeresultthatdentalschoolstraditionallyhavehadwidelati-tudeinhowmuchtimetheydevotetosubjectmatter.Infactin200809theADACurriculumSurveyshowedthattherangeoftotalhoursvar-iedfrom3531to6954.Therewasalsogreatvariationincurriculumtimeforeachofthemajorblocksofsubjectmat-terspecificallybasicbiomedicalsciencespreclinicalscienceandclinicalsciences.Forexamplethevariationamongschoolsinbiomedicalsciencescoursehoursisbetween452and1455hours.TheschoolswiththefewestreportedbiomedicalscienceshoursUni-versityofCaliforniaSanFranciscoandthehighestnumberofhoursHarvardUniversityarebothhighlyrespectedschools.5BertolamiquotesfromDr.PeterPolverinideanoftheUniversityofMichiganSchoolofDentistryandhostofaninvitation-onlyconferenceinAnnArborinstatingthatforthefirsttimeinnearlyacenturytheimportanceofthebiomedicalsciencesinthedentalschoolcurriculumisbeingchallengedbythisnewdirectionindentaleduca-tion.6Infactwidelatitudeamongschoolsontheemphasisofthebiomed-icalscienceshasalwaysexisted.Interest-inglyofthethreenewschoolslistedinthe200809AmericanDentalEducationsurveyofdentaleducationonereportsover1000hoursofbiomedicalsciencesinstructionA.T.Still-Arizonaandtworeport505and546hoursofinstruction201315 16WinTerMidwesternUniversityDentalSchoolandNovaSoutheasternUniversityCol-legeofDentalMedicinerespectivelymorehoursthantheUniversityofCali-forniaSanFranciscoandclosetoBostonUniversitysGoldmanSchoolofDentalMedicinewhichoffers597hours.Similarvariabilitycanbeseeninthepercentoftheclinicalcurriculumde-votedtopatientcareinschoolclinicsver-suscommunitylocations.Evenbeforetheestablishmentofthenewdentalschoolstherewasnoconsensusontheemphasisinthecurriculumrequiredtoeducateadentist.Thedataclearlyshowthatthereismuchvariabilityinwhattheestablisheddentalschoolsconsidernecessarytoedu-catestudents.Thesameistrueofnewschools.Simplyputthenumberofcoursehoursdevotedtothemajorblocksofcoursecontentdonotnecessarilyequatewiththequalityofeducationnorshouldtheybeconsideredrepresentativeofadentalschoolseducationalphilosophy.thinsuonalSngfodnaleucaonanhrsachMssonToelevatedentaleducationfrompro-prietarystatusandtoimprovepedagogytheGiesReportrecommendedthatalldentalschoolsbepartofthehigheruni-versitysystemintheUnitedStatesandCanada.Bertolamisuggeststhatthenewschoolsmaybeshortchangingresearchostensiblyinfavorofteachingandserv-iceandthattheyarenotlocatedinthebestuniversities.Hestatesthatdentalschoolsshouldbeinmajorresearchuni-versitiesandquestionswhetherthena-tionsfinestuniversitiesmaynotopttohaveadentalschool.Hesuggeststhattheincorporationofdentalschoolsintothefinestresearchuniversitiesisawayforwardfordentistryinreinventingit-selfnotonlyasadisciplineandvocationbutasalearnedprofession.UsingNationalInstituteofDentalandCraniofacialNIDCRgrantsup-portasamarkerofaschoolsresearchproductivityabouthalfor34ofthe62operatingdentalschoolsintheUnitedStateshadgrantsof1millionormorein2011.7MostofthefundedschoolsareinthepublicorprivateCarnegieDoctoralRe-searchUniversities-ExtensivecategorythetermResearchIUniversitiesisnolongerused.Theseschoolsmustmeetthemissionoftheiruniversitiesthroughfacultyresearchprogramsthatareonaparwithotherswithintheuniversity.The34schoolsonthelistaregenerallyrecognizedasdoingso.Intotalthe62schoolsbreakdownasfollows37areinthepublicorprivateCarnegieDoc-toralResearchUniversities-Extensivecategoryand25areintheCarnegieFoundationSpecializedMedicalinstitu-tionsorsimilarcampusescategory.ThelattercategorywasinstitutedbyCarnegietorecognizethemanyaca-demicmedicalcentersthatwereestab-lishedinthe1960sand1970sthatwerenotpartofanexistinguniversity.Re-searchinascholarlyenvironmentisgoingonnotonlyindentalschoolsthatareabletoobtaingrantfundingfromNIDCRorthosethatarepartofCarnegieResearch-IntensiveUniversitiesbutalsoinschoolsthathaveamissionthatincludesaheavycommitmenttocommu-nityserviceandservicelearning.8BoyerinScholarshipReconsideredPrioritiesoftheProfessoriatebroadensthecategoryofresearchtoincludeschol-arshipofintegrationapplicationandteachinginwhichfacultyintegratein-terpretandapplyresearchfindingstoproblemsinsociety.9UnfortunatelyitappearsthatBertolamiusingwording 201317fromthePolveriniarticle6narrowlydefinesresearchinthetermsofbasicbiologyoforalstructureandthepathol-ogyoforal-facialdisease.Thisleavesoutthemanyquestionsinherentinbeingaprofessionthatisinservicetothepub-lic.Scholarlyresearchinalltheseareaspublichealthsociologyhealthservicesbioethicsandeconomicsisimportanttothesocietalroledentistryplays.Inmanyoftheestablisheddentalschoolsthistypeofscholarlyactivityiseitherself-fundedbyschoolsanduniversitiesorfundedbyfoundations.Newschoolsaswellasestablishedschoolscancreateascholarlyenvironmentwithapublicserv-iceorsocietalmissioninmind.Schoolsthatemphasizecommunityserviceoftenareengagedwithsuchre-searchandcanjustasoftenbeinCarnegieResearch-IntensiveUniversitiesandoracademicmedicalcentersasonosteopathicmedicalcampuses.Apre-vailingenvironmentcongenialtointellec-tualactivitycanonlygoonaccordingtoBertolamifromresearchaboutdis-coveringnewtreatmentscuresanddiag-nosticmethodsnotnecessarilyaboutteachingstudents.Italicsaremine.Thisisanarrowviewofscholarshipandim-pliesthatpedagogyisnotabletocreateascholarlyenvironment.HoweverBoyerinScholarshipReconsideredfurtherrec-ognizesscholarshipofteachingwhichcanbeseeninmanyrespectedliberalartscollegesanduniversities.Thisalsoap-pliestodentaleducation.Researchuniversitiesarebeginningtorecognizetheimportanceofteachingintheirtenuredecisions.BoyerfurthernotedthatWhendefinedasscholarshiphoweverteachingbotheducatesanden-ticesfuturescholars.IndeedasAristotlesaidTeachingisthehighestformofun-derstanding.theAccediaionPocessBenchmakingandrankingsAccreditationBertolamisessayispessimisticaboutthefutureofdentaleducationbasedonwhathecallsthearrivalofatwo-tiersys-temofschoolsengenderedbytheopen-ingofnewschoolsassociatedwithosteopathicmedicine.Becauseitappearsthattheseschoolsemphasizecommunityserviceintheirmissionitisin-ferredthattheywillbringdowntheentireprofes-sionmakingitmorevocationthanlearned.Howeverthatisnotnecessarilytrueasamissionthatemphasizescommunityservicedoesnottranslateintoaschoolwithalackofscholarshipasdiscussedabove.Therehavealwaysbeendifferenttypesofdentalschoolssomemoreresearch-orientedthanothersjustastherearedif-ferenttypesofmedicalschoolsandlawschools.Thisdoesnotmeanthatwehaveatwo-tiersystemofdentaleducationofmedicaleducationoroflawschools.IndentistryalloftheschoolsadheretoasetofstandardssetupbytheAmericanDentalAssociationsCommissiononDentalAccreditationCODA.10AccordingtoBertolamimeetingCODAstandardsisnotsufficienttodif-ferentiateschoolsphilosophiescurricu-lumandoutcomes.Hesuggeststhatarankingsystemisneededtoinformthepublicandapplicantsandtodifferentiatebetweentheschoolsthatheinfersarepartofthetwo-tiersystem.Mycon-tentionisthatnorankingsystemwillprotectthepublicfromunsavorypracti-tionersanymorethandothecurrentli-censingregulationsofthestatesandtheCODAaccreditationprocess.Similarlynorankingsystemcanbedevisedthatisbetterthanthealreadyextensiveinfor-mationavailabletoinformstudentsofaschoolsphilosophyeducationalap-proachandoutcomes.Letsfirstbrieflyexaminetheaccreditationsystemsabilitytoassurethatthereisonlyonetierforalldentalschoolsthoseworthyofbeingaccreditedandthenlookatbenchmarkingandrankingsys-tems.CODAexam-inessixcriticalstandardsfordentalschoolsinstitutionalef-fectivenessedu-cationalprogramfacultyandstaffeducationalsupportservicespatientcareservicesandresearchprogram.Eachstandardhasasetofsubstandardswhichhavebeenrevisedconsistentwithestablishedtrendsindentaleducationandwithnationalrequirementsforac-creditedinstitutions.Accreditingteamsaredrawnfromknowledgeablefacultyandschoolsprepareaself-studyassess-mentinrelationtothestandards.Thestandardsareconstantlyreviewedup-gradedandtomymindrepresentwhatacontemporarydentalschoolshouldoffertostudents.Newschoolsaregrantedinitialaccreditationindicatingthatthedevelopingeducationprogramhasthepotentialformeetingthestan-dardsandthisstatusisgrantedafteroneormoresitevisitstotheschoolanduntiltheschoolisfullyoperational.Itshouldbenotedthatthenewschoolsarebeingledbydeansandfacultyrecruitedfromexistingschools.ItisbeyonddisputethatthefacultyisMycontentionisthatnorankingsystemwillprotectthepublicfromunsavorypractitionersanymorethandothecurrentlicensingregulationsofthestatesandtheCODAaccreditationprocess. 18WinTerthemostimportantingredientinthequalityofaschool.Whilethereareal-waysshortagesoffull-timefacultytheaccreditationprocesscloselyexaminesthenumberanddistributionoffacultyinrelationtotheschoolsmissiongoalsandobjectives.Theaccreditationstan-darddoesnotstipulateaspecificnumberoffacultyorthwartinnovationbutitas-suresthatthefacultyisabletomaintainthevitalityofacademicdentistryasthewellspringofalearnedprofession.Sothereisastandardthatpromotesalearnedprofessionavisionuponwhichtheentireprofessionagrees.Moreoversitevisitteamsarechargedwithassuringthatschoolsmeetthatstandard.IdisagreewithBertolamisessaybe-causetheaccred-itingprocessdoestakeintoconsid-erationdiffer-encesindentalschoolsmissionsandgoalsbutas-suresthatallschoolsnewandestablishedmeetstandardsthatareacceptedbytheacademythepracticingcom-munityandthelicensingcommunity.Ifallschoolsmeetthesestandardsthereisnotatwo-tiersysteminsteadthereisasystemthatallowsdifferencesinprogramaroundasetofcommonlyagreed-uponstandards.Thismakestheentiredentaleducationsystemdynamicandcompeti-tiveandkeepstheprofessionstrong.Dentistryhasmadeenormousadvancesasaprofessioninscientificunderstand-ingofdiseaseincludingpreventionandtreatmentfrombasictotranslationalre-searchandintopractice.Themeansareatourdisposalasaprofessionthroughaccreditationtokeeptheprofessionvitalandlearned.BenchmarkingandrankingsThefirstsystemforrankingdentalschoolsoccurredin1918attherequestoftheSurgeonGeneral.SchoolswereratedasClassABorCschools.2TheimplicationwasthatThegraduatesofClassAschoolsaremorecompetentthanthegraduatesofClassBandCschoolstopassagivenstateboardexam-ination.Howeverthatwasnotthecaseastherewasnocorrelationbetweenthetwo.GraduatesofClassBandCschoolswerejustaslikelytopasstheexamina-tionsasthoseofClassAschools.Therankingofdentalschoolswasdiscontin-uedintheearly1990sandtheCouncilonDen-talEducationthepredecessortoCODAwassetuptoexamineschoolsunderanaccreditationprocess.Idontagreethatbenchmark-ingorrankingsofschoolsisnec-essaryorwillprovidethepublicandap-plicantswithmoreinformationthanisalreadyavailable.Thepublicisassuredthroughaccreditationthatschoolsad-heretominimumstandardsandthattheirgraduatesarereadyforlicensure.Ina2010AmericanDentalEducationAs-sociationADEASymposiumAssess-mentPortraitsofChangeImadethefollowingcommentsrakofuvstsadaduatschoolsbcampopulawththlaypublcth1980swhthU.S.NewsandWorldReportbatsaksystm.Whlmdcalschoolsaakddtalschoolsaot.SomhavaskdwhyU.S.Newsdostakdtalschools.itallythwasaakfodtalschoolsbutaftxamthakmthodoloythwasaback-lashbydtalducatosaastthaksystmadalldtalschoolsfusdtopatcpat.itwasvwdasapopulatyop-opollofthfacultyadadm-statoswhoaswdthsuvyaththaatuassssmtofthschools.Dtstysttholycompotofhhduca-totoctczthaksbutwatholyoswhohavbabltokpoutofwhatmaycosdaawdsystmthatdostfalypstthqualtyofpoams.ThU.S.Newsaksystmhascomudmuchctcsmadsomctcsstatthattsjustalstofctathatmosthsupcalchaactstcsofltcollsaduvsts11ThaksabbusssfoU.S.Newsthptdssuofthaksslls50pctmomaazsthathulassuadthwbsthas10mllopavwsoaaksssucompadto500000atypcalmoth.gvthawdatuofthU.S.Newsaksaoupot-talstudtsbttoslct-adtalschooltoattdwthoutdtstybcluddPottalstudtsfodtstyhavtodomosachadafabttfomdaboutschoolsfomthsachthabybldlyfollowthU.S.Newsaksoayothsuchak-IdisagreewithBertolamisessaybecausetheaccreditingprocessdoestakeintoconsid-erationdierencesindentalschoolsmissionsandgoalsbutassuresthatallschoolsnewandestablishedmeetstandardsthatareacceptedbytheacademythepracticingcommunityandthelicensingcommunity. 201319s.Pdtlstdtsssmhfmtd-tlshlstmkfmdds.ThaDaalSvyfDtlShlshsplthfdtfmshst-sdfmstdttttlvllkd.ThldtdtlshlspblshdbyaDeahsxtsvfmtvyshlldthvDaTdgPassflltstdts.ThniDcrwbsthskfshdlls-vdbydtlshls.astdyf239ppltstthuvstyfPttsbhdmsttdthtvppltsvstd13dtdtlshlwbstsdfdthtfmttttlsssttstsDaTgPadmssq-mtspttsdd-vstytbwhtthyshtthmst.Ftyptfthp-pltsdtdthtthybsddssqllythdtlshlwbstsdthss.12ofsllstdtslslypsdp-hlthdv-ssbtthyshthWbttswstthmstmpttqsts.Swd-pdstdtsdthwshdthbstshlfthmtttdththsmthdptyshsthU.S.Newsks.Psllyidthhvstdtwhdshshwshddm-sttsdpdtthkthswydbyspl-dmslksystm.AnewrankingsystemalongthelinesthatBertolamisuggestswillbesubjecttothesamefoiblesastheClassABandCrankingsofoldandthesamesubjectivetypeofrankingsasseenintheU.S.NewsandWorldReport.Whosetsuptheval-uesandhowdoyougetbalancebetweenthesocialmissionandtheresearchmissionThethoughtbehindBertolamisrankingsystemasdelineatedinhisessayisitseemstomebasedonabiasedper-spectivethatisunlessschoolsareinre-search-intensiveuniversitiestheyareunabletocreateascholarlyenvironmentandtoeducatethinkingprofessionalsofthehighestlevels.Therankingsystemproposedwillnotimprovetheprofes-sion.Weshouldkeepinmindthatallofourdentalstudentsarewellpreparedandcanthinkforthemselvesinselectingadentalschool.Eighty-ninepercentofenrolleddentalstudentsholdbachelorsdegreeswhileonly30percentof25-year-oldsingeneralholdbachelorsdegreesand7.1percentofdentalschoolen-rolleesholdmastersorhigher-levelde-grees.Thesewell-preparedstudentsare 20WinTerenrollingintheestablishedschoolsaswellasinthenewschools.Ihaveconfi-dencethatthenextgenerationwillcon-tinuethetraditionofimprovingtheprofessionandconcernforthepublicswelfarethuskeepingthedentalprofes-sionstrong.inSummayDentaleducationhasservedthepro-fessionofdentistryandthepublicwelloverthecourseofthe20thcenturyandintothe21stcentury.Startlingadvancesinscienceandtechnologyhavedramati-callyimprovedtreatmentandpreventionandthepublicratesdentistryasaprofes-siontobetrusted.Schoolsinresearchuniversitieshaveaddedimmenselytotheknowledgebaseofdisease.Howeversincethe1960sdentalschoolshavereal-izedtheirobligationtoreconsidertheirpatientcareandservicemissions.Schoolsreorganizedclinicalprogramstoemphasizecomprehensivepatientcareinwhichstudentslearntoconsidertheentirepatientfromasociomedicalper-spective.In2000theUSsurgeongen-eralsreportOralHealthinAmericajoltedthepublicandprofessionintorealizingthatwehadleftalotofpeoplebehindingainingthebenefitsofpreven-tionandinterventionoforaldisease.Accordinglyforthepastdecadewhenschoolswerereconsideringtheirmissioncommunityserviceandservicelearningbecamelegitimatemissionsandarespon-sibilityforallschools.StatelegislatorsrecognizedthatschoolclinicsarepartofthesafetynetsystemintheUnitedStatesandoutreachtounderservedpopulationsisimportant.Itisntsurprisingthenthatnewschoolswouldseeanimportantnichefortheirmission.Thisdoesnotmeanthatbecausesomeschoolswillfocusmoreheavilyonthepublicservicemissiontheywillbelesserschoolsrelegatedtoasecondtier.Allschoolscanachieveascholarlyenvironmentandeducatelearnedprofessionalswiththecapacitytoserveonfacultiesinprivatepracticeandinthepublichealthsystem.Thisisnottosaythattherearenotmanyproblemsfortheeducationcom-munitytograpplewithinordertokeepthesystemstrong.Problemareasincludehightuitioninallschoolsasignificantdecreaseinstatesupporttothepublicschoolsabetterappreciationfortheneedtounderstandworkforceissuesincludingabetterunderstandingofpop-ulation-to-dentistneedsthepotentialfornewerformsofalliedhealthdentalworkerstoenhancepractitionersabilitytotreatthegrowingnumberofchildrenandolderadultsinneedoforalhealthservicesandoutreachtothosewhoaredisabledandpoor.Withintheacademyitisimportanttoemphasizeinterprofessionaleducationalcollaborationswithmedicinenursingandtheotherhealthcareprofessionsthatcanyieldamorecoordinatedandhigher-qualityhealthsystem.Thereisaneedtorecommittoprovidingapostgraduateyearforeverygraduategiventhecom-plexitiesoftodayspracticeenvironment.Arankingsystemwillhavenoeffectontheseimportantissues.ByconstantlystrivingforexcellencewithineachschoolandthroughparticipationintheschoolsorganizationADEAandtheCommis-siononDentalAccreditationCODAstandardscanbekepthigh.Discussionanddebateofthesemajorissuesarecon-tinuallyneededtosharpenourthoughtsandkeeptheprofessionstrong.Schoolswillchange.Howeverthebasicvaluesin-trinsictotheprofessionoverthepast100yearsshouldnot.refeences1.BertolamiCN.ThedentaleducationbubblearewereadyforaLEED-styleratingJADEInternet.2013115-13.Availablefromhttpwww.nyujade.org2.GiesWJ.DentaleducationintheUnitedStatesandCanadaareporttotheCarnegieFoundationfortheAdvancementofTeaching.BulletinNo.19.NewYorkTheFoundation1926.pp.xivxvxvii106-108182.3.ORourkeJMinerL.DentaleducationintheUnitedStates.PhiladelphiaW.B.Saunders1941.4.CommitteeontheFutureofDentalEducationInstituteofMedicine.Dentaleducationatthecrossroadschallengesandchange.FieldMJedi-tor.WashingtonDCNationalAcademiesPress1995.5.AmericanDentalAssociationSurveyCenter.20082009curriculumsurvey.Vol.4tables57.ChicagoTheAssociation2010.6.PolveriniP.TheAnnArborDentalDeansForumcraftingaresponsetotheemergingtieredsystemofdentaleducation.GlobalHealthNexus.201012224-27.7.NationalInstituteofDentalandCraniofacialResearch.GrantstoUSdentalinstitutionsFY2011Internet.Availablefromhttpwww.nidcr.nih.govGrantsAndFundingNIDCR_Funding_to_US_SchoolsDentalSchoolsGrantstoDentalInstitutions2011.htm8.TheCarnegieFoundationfortheAdvancementofTeaching.TheCarnegieclassificationofinstitu-tionsofhighereducationInternet.Availablefromhttpclassifications.carnegiefoundation.org9.BoyerEL.Scholarshipreconsideredprioritiesoftheprofessoriate.AspecialreportoftheCarnegieFoundationfortheAdvancementofTeaching.SanFranciscoJossey-Bass1997.10.CommissiononDentalAccreditationAmeri-canDentalAssociation.AccreditationstandardsfordentaleducationprogramsInternet.2010.Availablefromhttpwww.ada.orgsectionseducationAndCareerspdfspredoc_2013.pdf11.CareyK.Collegerankingsreformed.EducSec-torReportsInternet.2006Sep20.Availablefromhttpwww.educationsector.orgresearchresearch_show.htmdoc_id40423012.SpallekHEtzelKMaherB.Dentalschoolapplicantsuseofwebsiteinformationduringtheapplicationprocess.JDentEduc.200569121359-1367. IamnotadentistandIthinkthattheclosestIhaveevercometoadentalschoolwaswhenIwasanadolescentontheLowerEastSideofNewYorkbeforeitwashot.IwasapatientattheNYUCollegeofDentistry.NeverthelessdespitethisslightacquaintanceIfoundtheexchangebetweenCharlesN.BertolamiandAllanJ.Formicolacompellingfortworeasons.FirstasaprofessorofpublichealthIhavespentthebetterpartofthepastthreeyearsengagedinrethinkingthecorecurriculumatColumbiaUniversitysMailmanSchoolofPublicHealthandsoIhaveconfrontedthequestionofwhatitmeanstoeducatenotsimplytrainprofessionalswhosemissionistoadvanceourcollectivewell-being.Henceitwasilluminatingtowitnessandlearnaboutthefiercedebatethatcharacterizestheworldofdentaleducation.SecondassomeonewhohasworkedontheissuesofpublichealthIhavethoughtnotonlyaboutthedutyofprofessionalstoprovideneededcarebutalsoaboutthemuchbroaderandfarmoreimportantquestionsofwhatthestatehasadutytodotoassureequitableaccesstohealthcareservicestocreatejusthealthcaresystemsandtosecurethesocialconditionsthatpromotehealthandlimitdiseaseanddisability.InthisbriefcommentaryIcannothopetodomorethantouchontheseissues.eucagatagdssItisclearthatwewantdentistsaswellasphysicianstobetechnicallycompetentsothattheycandiagnoseandtreatthemaladiesthataffectus.Whatscientificbaseisnecessaryforsuchtechnicalcapacityisclearlyamatterofopendisputeamongdentalschoolsevenamongthoselocatedingreatuniversities.Asinterestingtomeisthequestionofhowdentistsareexposedtobiostatisticsepidemiologyandthesocialandbehavioralsciences.Onecanbetrainedtododentalprophylaxisfillcavitiesanddosimpleextractions.Buttounderstandwhydentaldiseasetakesforminvariousso-cialclassesandatparticularmomentsinhistoryrequiresfarmore.Tounderstandwhydietarychangesoccurandwhattheirimpactsareintermsofthedistributionofdentaldiseasebyclassandraceeth-nicitynecessitatesaneducationthatisbothdisciplinedandbroaderthanthatwhichisconventionallythoughtofasinvolvingonlyagoodtoolkit.Tounderstandtheforcesthatmakepossibleorthatcreateimpedi-mentstopublichealthpolicywithimplicationsfordentalhealthrequiresmorethandentaltraining.Finallytofullyunderstandtheethi-calresponsibilityofdentistsasprofessionalsandthedentalprofessioncollectivelydemandsaneducationthatgoesbeyondtheabilitytoreciteasimplecodeofethics.theCoreMiSSionoFDenTaleDucaTionralBayPDPrfssrdc-rctrfrthstryfetsPbhtmSfPbhtcbuvrstyIhavespentthebetterpartofthepastthreeyearsengagedinrethinkingthecorecurriculumatColumbiaUniversitysMailmanSchoolofPublicHealthandsoIhaveconfrontedthequestionofwhatitmeanstoeducatenotsimplytrainprofessionalswhosemissionistoadvanceourcollectivewell-being.201321 22WinTerItisofcourseanempiricalquestionofwhetherfreestand-ingdentalschoolsthatareconceivedofimplicitlyorexplicitlyasfor-profitinstitutionsorthatareembeddedinuniversitiesthatareframedbyaprofitmo-tivecanprovidethebroadedu-cationthatIhavealludedtobutIhavemydoubts.Mydoubtsstemfromasuspicionthatthereisadeepclashbetweentheval-uesthatinformthechoicesoffor-profitinstitutionsandthemarketplacemoregenerallyandthevaluesofthoseinstitutionsthatseethemselvesasservingabroadlydefinedpublicgood.JusticeThisleadsmetomyfinalpoint.InboththeBertolamiandFormicolaessaysthereareallusionstodentalinequitiesthatistheextenttowhichaccesstodentalservicesisaffectedbyso-cialclass.TheUnitedStatesasweknowtoowellistheonlyadvancedindustrialdemocracythatdoesnotguaranteeaccesstohealthcaretoallitscitizens.FiftymillionAmericanshavenohealthinsurancemanymorearecoveredbyinadequatein-surance.Fordecadesreformerssoughttoaddressthisglaringinequity.WiththepassageoftheAffordableCareActanditsgrad-ualimplementationtherewillbeextraordinaryprogress.Butsomewillbeleftbehind.WhatisthestorywithdentalcareHowmanycannotgetthecaretheyneedHowmanymustpayout-of-pocketchargesthatareveryburdensomeorsoburden-somethatneededcareisdelayedThesearequestionsthatwell-educateddentistsandthedentalprofessionasawholeneedtoaddress.Theyarequestionsthatcannotberesolvedbyappealstocharitycareorpublicclinicsforthepoor.Theyrequireaneffortbytheprofessiontoargueandpressforaguaranteedrighttodentalcareaspartofabroaderrighttohealthcareservices.Raisingthisquestioninasystematicwayrequiresun-derstandingthesocialforcesthatmayfosterorimpedethepathtodentaljustice.ThisoughttobeacoremissionofdentaleducationintheUnitedStates.Itisofcourseanempiricalquestionofwhetherfreestandingdentalschoolsthatareconceivedofimplicitlyorexplicitlyasfor-protinstitutionsorthatareembeddedinuniversitiesthatareframedbyaprotmotivecanprovidethebroadeducationthatIhavealludedtobutIhavemydoubts.