Transforming the Culture of Dental Schools and Dental Education
Advances in oral health research are moving dentistry farther and farther away from its traditional roots in technical/clinical excellence and restorative intervention, and closer to prevention and biological approaches that constitute individualized medicine based in new science and technologies. Examples of the integration of oral health research into the broader science community include the oral-systemic connection, biological sensors and associated nanotechnology, and tissue regeneration.
To keep pace with these changes, graduates must be capable of critical/analytical thinking and must be thoroughly familiar with the use of evidence-based practice and the management of electronic information. This will require changing the culture of dental schools, dental education, and the research enterprise.
Research must become part of the daily fabric of the dental education process and be continually reinforced and utilized in classrooms, clinics, and associated activities, creating an environment that encourages faculty/students to monitor and embrace the latest science. Research must function as the glue that binds and supports teaching/learning strategies, foundational knowledge, and patient care. By incorporating research into the daily routine, we will produce graduates who are likely to apply evidence-based strategies to their practices, engage in lifelong learning, and be sophisticated consumers of research so that they can be early adopters, embracing the the latest scientific advances in patient care.
I believe that research must be defined very broadly to include educational investigations as well as traditional notions of basic biomedical science bench studies, clinical trials, and translational studies. Within this context, research becomes something that all constituencies and stakeholders can participate in and understand, regardless of background, interests, or skill sets. It becomes a true common denominator linking the dental school, parent university/health science center, and external community. As a result, a consumer base is created for the research product, one that attaches value and utility to new knowledge and its application to clinical practice and population health.
The challenge is to find ways to be inclusive and to involve those who would be the end users of new information. Critical thinking skills must be seamlessly integrated into evidence-based, case-based, or problem-based teaching approaches. Students and clinical faculty must be involved in the research enterprise, and all dental schools, regardless of research infrastructure, must be included in the national/international research agenda.
It’s important to point out that a broad-based, on-campus research community can just as easily be built at non-research-intensive institutions as at research-intensive institutions. Indeed, I have found that when a commitment has been made to change the culture, non-research-intensive institutions are capable of doing an even better job connecting with students and fostering positive attitudes toward research/scholarship. Even though the amount and level of science at these institutions may be less, the ability to form personal and productive mentoring relationships with students is greater. Rather than focus on the rigor of the science, emphasis is placed on making sure that the experience is an enjoyable one for the student; that the student understands the scientific, evidence-based approach; and that the student becomes enamored of the academic life.
Too often, research is regarded as an afterthought or something that other people do. Traditional approaches have created very large groups of disenfranchised students and clinical faculty who do not have an appreciation of the value of new knowledge and technologies. Unfortunately, elite scientists and institutions often have no constituency for their output other than each other or the reagent bottles in their laboratories. One research-intensive dental school that shall remain nameless actually separates its elite researchers from the rest of the school by a door with a sign that proclaims do not knock. These researchers should not be isolated; instead, they should be highly integrated as mentors for students and clinical faculty, and efforts should be made to ensure that they are key members of translational and applied teaching/learning activities. Ultimately, this process produces an eager and energetic graduate who is more likely to seriously pursue advanced education/training programs and become a biologically oriented practitioner capable of applying new knowledge to patient care. This is a transformational experience that elevates institutional pride and morale like no other and it can succeed at any dental school.
Also key to transforming the culture of dental schools and dental education is a commitment to developing faculty who are men and women of science, who can be role models for students. One cannot produce something if he/she is not familiar with what it should look like in the end. Without exception, all the dental schools I have been associated with have incorporated aggressive and comprehensive faculty development programs into their overall plans for culture change. In my opinion, a dental school cannot be successful without this important component. I believe that dental schools should consider a multiyear plan, with several activities each year related to integration and collaborative teaching of basic, clinical, and behavioral sciences; evidence-based, case-based, and/or problem-based learning; and use of electronic resources and technology in teaching, assessment, and mentorship.
This kind of planning is critical if we are to find effective ways of connecting with our practicing communities through continuing education and dissemination of new practice models. The medical community is far ahead of the dental community in this regard. Physicians have been using evidence-based and prevention-based approaches for many years and we are struggling to catch up. The dynamics of the medical practice environment require much more collaboration with colleagues and use of electronic technologies. The medical education program also has a stronger emphasis on research/scholarship and the applications of new science to clinical practice.
The new model of dental education that I describe -- essentially a change in the culture of dental schools -- is essential to ensure the scientific future of the profession.