A number of my fellow dental deans and I have growing concerns about issues that are not being addressed that we feel are pivotal to the future of the profession. Our concern centers on the emergence of a tiered system of dental education resulting from the opening over the past decade of a number of dental schools without a clear research mission. It is a "sine qua non" that research-intensive universities demand that all schools and colleges affiliated with their universities, including dental schools, demonstrate certain standards of excellence in terms of research and discovery. Indeed, such schools are looked upon as full partners within the mission of the university. But with the rise of dental schools that don''t have a credible research program, the issue becomes: "Who is going to lead the profession into the future if all we are doing is training dentists to be technically competent?"
As a first step toward formulating a response to this development, I decided to organize the Ann Arbor Dental Deans Forum by inviting approximately 30 dental deans or their representatives from the US and Canada to come to Ann Arbor May 20–22, 2010, to help set forth the standards that have to be met in order to keep dentistry moving forward.
The Forum's purpose was to make a clear statement that it is the research-intensive dental schools that must lead the profession into the future. If we don't make that statement, I think we're making a dangerous mistake about the standing of the dental profession going forward. To put it another way, if we give up science, and don't link research and discovery with dentistry, we will begin to look more like a trade than a profession, a posture that jeopardizes the long-term prestige and progress of the dental profession.
In 1926, the publication of the Gies Report stressed the importance of the biomedical sciences in the dental school curriculum and advocated that dental schools initiate research in the basic biology of oral structure and the pathology of oral-facial disease. Now, for the first time in nearly a century, that position is being challenged by this new direction in dental education, which is based on the premise that a shift from an emphasis on research to teaching is required to provide more care for underserved populations.
Financially driven resource issues also play a role in explaining the rise of the non-research-oriented dental schools. Since dental education is the most expensive health professions education program on a per student basis, financial challenges have loomed increasingly large over the past several decades, as both federal and state support for dental education has declined drastically. A dental education management model that reduces operating costs by contracting out the basic sciences to a non-residential basic science faculty and shifting institutional priorities from the traditional clinical education, research, and patient care model to an emphasis on clinical education and care can initially appear attractive. But once you mortgage the responsibility of basic and translational research to someone else, you essentially lose control over the future of the profession.
We believe that research and discovery must be a credible part of a dental school's mission, not something that you import when you need it and export when you don't. Our challenge is to convince legislators and other academic institutions that they should be looking to us for the future and really think very carefully about this tiered system of dental schools.
Today, dentistry is on the outside of the healthcare debate, looking in. For many reasons, dentistry has never been linked to the medical network. But unless dentistry becomes part of the solution to the challenge of providing comprehensive patient care, it will be looked on as part of the problem, and ultimately, all dental schools will be called into question. Accordingly, while the new model of dental education will no doubt produce technically competent dentists in the short term, without an internal culture of science, the contributions of graduates of such schools may be viewed as less valuable a generation from now.
The Forum's Stucture
To help frame the topics, I invited Dr. Lawrence Tabak, Director of the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health (NIH), to participate in our meeting. Dr. Tabak underscored the importance of the role that dental schools play in advancing the NIDCR mission to improve oral, dental, and craniofacial health through research, training, and the dissemination of health information.
Within that context, the Forum dealt with the following topics:
- How must research-intensive dental schools assert leadership in the emerging tiered system of dental education?
- What is our leadership position and strategy?
- What should our relationship be to non-research- intensive dental schools?
- What is our relationship to ADEA and does ADEA represent the interests of research-intensive dental schools?
- Should the Commission on Dental Accreditation (CODA) continue to define and shape the future of dental education and the profession alone—or are there key roles that should be assumed/managed by research-intensive dental schools?
- How must research-intensive dental schools apply educational innovation, scholarly excellence, and academic leadership to affirm their intrinsic value to their parent universities?
- How can research-intensive dental schools balance expectations for education and scholarship with the expectations of their university and the profession?
- What best practices are needed to sustain the pipeline of academic dental school faculty?
- What should we be doing to increase NIDCR and NIH funding to dental school researchers?
- What are some best practices for mentoring junior faculty for productive academic careers and for sustaining the productivity of mid-career faculty?
- Should the mission of research-intensive dental schools change and focus more on postgraduate education and develop more innovative predoctoral programs?
- What strategies must research-intensive dental schools advance to facilitate collaboration and sharing of academic resources within their parent university and with other dental schools?
- What are some of the barriers to intra- and inter-institutional collaboration for research and what strategies must be developed to overcome them?
- What are ways that research-intensive dental schools can establish an inventory of scientific expertise to promote research/educational collaborations and share scientific resources through the establishment of affinity groups?
- What are ways that research-intensive dental schools can become more directly aligned with other health sciences to enhance research opportunities and develop innovative, better-integrated education and patient care programs?
The Forum succeeded in promoting an in-depth discussion of these issues, concluding with a summary of the proceedings and a decision on next steps, including publication of the proceedings. My hope is that the participants will continue to work together and, indeed, agree to collaborate in writing the next Gies Report—a Gies Report for the 21st century. Interestingly, Dr. Gies used the University of Michigan as one of six dental schools that included Harvard, California, Iowa, Minnesota, and Pennsylvania that made dental education a function of a university. The University of Michigan Dental School decided to host these same schools in Ann Arbor, Michigan, to catalyze the direction in which we want to see the profession move in the coming years. Stay tuned.