As a former associate director for public health programs in the California Department of Health Services and former area health officer serving the west area of the Los Angeles County Department of Health Services, my vision as inaugural dean of the Arizona School of Dentistry & Oral Health (ASDOH) is strongly colored by my public health education and professional background. That vision, simply stated, is to fill a public health niche. And because we are a new school, founded in 2003, we have the luxury of starting from scratch, which makes us a very agile organization.
ASDOH recognizes that the traditional model of dental education is not as relevant as it once was, and that to be relevant, dental education must constantly evolve. We also recognize that there is no perfect solution to the education and training of tomorrow's dentists, but one possibility, which we have adopted, is an educational model that seeks to educate strongly community-minded dentists who are well equipped not solely to meet dental needs, but also to integrate dental care into total health care, especially as it concerns the needs of inner-city and rural populations. Our students are being groomed to have a greater understanding of systemic health, a greater willingness to be linked to the medical community, and a greater commitment to improve overall health, rather than just teeth.
The ASDOH Model
To produce the kind of dentist who embodies the ASDOH vision, we realized at the outset that we had to make curricular reform a priority. Indeed, if we were to succeed in integrating a significant amount of community-based and interdisciplinary elements into the curriculum, it was incumbent on us to drastically revise the traditional, jam-packed dental education curriculum.
One of our most important decisions in that regard was to eliminate the traditional first-year basic sciences curriculum of separate courses in biochemistry, biology, physiology, pharmacology, and anatomy, and to replace it with a comprehensive, biomedical modular approach of one- to two-week courses focusing on body systems, including the circulatory, digestive, endocrine, immune, lymphatic, muscular, respiratory, and neurological systems. Moreover, rather than employ a residential basic science faculty, we decided to bring in external basic science faculty who work in intense, one-on-one relationships with students in these modules and then stay in contact with them throughout the course of their first year.
This approach has proven remarkably successful. Our students take the national boards right after their first year, rather than after their second year; and our students to date have achieved a 94 percent pass rate the first time they have taken the test.
Another successful innovation involves having every full-time clinical faculty member take one of the first-year basic science modules along with the students. The faculty members develop clinical cases based on what they learned in the module, which are then presented to students for study in their third year. This approach creates a bridge from the basic science modules to the clinical care environment and allows students to understand the connection between their basic sciences education and the clinical care they are learning to provide.
The ASDOH model relies on an exceptional cadre of motivated, experienced learning guides who work closely with students in both the preclinical and clinical phases of the degree program. This is a more student-centered approach than in traditional dental education, and it requires a high degree of mentoring and nurturing by the faculty, none of whom, including the dean, is tenured, since we believe that tenure sometimes breeds complacency and we want all of our faculty to be at the top of their game. In a similar vein, instead of having department chairs, we have co-directors; and while the distinction may be subtle, we believe it advances our goal of creating a less hierarchical, more collaborative approach to dental education. As with the modular approach to basic sciences education, this decision has yielded impressive results, as exemplified by the fact that the 2009 graduating class achieved a 100 percent pass rate on the Western Regional Board Examination.
Our highly motivated faculty members are matched by a carefully chosen student body. ASDOH places a very high value on community service as part of the admissions process, and since we receive over 3,200 applications each year for 69 slots, our admissions process is necessarily highly selective. The kind of student we are looking for may not be the kind of student that other dental colleges are looking for, but we are committed to selecting students who not only have excellent academic credentials but who also have built a record of community service over a long period of time.
That spirit of community service is nurtured throughout the curriculum. Indeed, each student is required to plan and implement three community service projects each year and all fourth-year students spend four weeks as comprehensive care providers, treating people at over 65 sites in VA hospitals, community centers, and homeless shelters in locations as disparate as Alaska (see related story on p. 82), Montana, Maine, Florida, Texas, California, and New Mexico, where they treat 8–12 patients a day. Because they gain such robust clinical experience, all ASDOH students graduate with a certificate in public health as well as a DMD degree, and many go on to complete a master's degree in public health. It is our hope that when these students graduate, they will return to their hometown health centers to provide care in the communities that need it most.
To that end, we have developed a strong partnership with the National Association of Community Health Centers, which recommends students from their component centers for admission to ASDOH. These students are all guaranteed an interview, and, if accepted, they are strongly encouraged throughout their dental education program to return to practice in their hometowns after graduation.
Giving People a Healthcare "Home"
Data from national surveys indicate that patients in dental care are not necessarily linked to a healthcare "home," meaning that they may have significant unmet primary care medical needs. At ASDOH, we view this situation as an opportunity to educate our students to expand the boundaries of the care they provide and to reach out to other healthcare providers to integrate total health care into oral health care and oral health care into total health care, so that whether patients see only a dentist, or only a medical provider, they will nevertheless have a comprehensive healthcare "home."
To achieve this objective, we teach our students to be more interdisciplinary and interprofessional and more community-minded than they have been in the past; to place a greater overall emphasis on prevention and population-based issues that determine health, including tobacco cessation, and to become more involved in the social sciences, because all of these activities will make them more comfortable working with physicians, physician assistants, and other healthcare providers to provide comprehensive patient care.
For example, if we at ASDOH see a patient with severe periodontal disease, we want our students to feel obligated to contact a local physician or physician's assistant and to offer to work together to determine if that patient has undiagnosed systemic disease and to formulate a plan to put the patient on the path to improved overall health.
Decisions about dental education that shape the public's health are not made casually. But if positive change is to occur, dental educators must be willing to take risks and to encourage their students to be less risk-averse. As I tell my students, "for a turtle to go forward, he's got to stick his neck out." That's what's happening to dental education—it's starting to turn a corner and I'm glad to be on the bus.