Minority dental faculty development: responsibility and challenge.

Over at least the last twenty years, the American Dental Education Association (ADEA) has given attention and priority to increasing the number of underrepresented minority (URM) dental school applicants, enrollees, and faculty members and to meeting the challenges of achieving diversity in the oral health workforce of the future as racial and ethnic minorities continue to grow and are expected to comprise more than 50 percent of the U.S. population by the middle of the twenty-first century. Dental schools have the responsibility of preparing dentists to provide oral health care for the nation's population. This includes creating a workforce of adequate size and racial/ethnic composition. As part of ADEA's priorities to improve the recruitment, retention, and development of URMs in the dental profession, with funding from the W.K. Kellogg Foundation, ADEA launched the Minority Dental Faculty Development Program in 2004. The intent of the program is to foster academic partnerships, mentoring, and institutional commitment and leadership designed to increase the number of URM individuals interested in and prepared for careers in academic dentistry.

Dental school vacant budgeted faculty positions, academic years 2005-06 and 2006-07.

The annual turnover of dental school faculty creates a varying number of vacant budgeted positions at any given time. The American Dental Education Association (ADEA) conducts an annual survey to determine the status and characteristics of these vacant faculty positions. In addition, ADEA conducts an annual survey of dental educators to maintain a database on the size and characteristics of dental school faculty, including data on the distribution of full-time, part-time, and volunteer faculty, reasons for faculty separations, and sources of new faculty. The number of vacant budgeted faculty positions within U.S. dental schools increased throughout the 1990s, with a peak of 358 positions in 2000. Following this peak, the number of vacancies declined, falling to 275 in 2004-05. Since that time, there has been a rapid increase in the number of estimated vacancies, reaching 417 in 2005-06, then falling slightly to 406 in 2006-07. The 2005-06 and 2006-07 faculty vacancies surveys explore these increases, along with information relevant to trends in the faculty workforce, factors influencing faculty vacancies, and the impact of vacant positions on dental schools.

U.S. state-supported dental schools: financial projections and implications.

This article examines the impact of financial trends in state-supported dental schools on full-time clinical faculty; the diversity of dental students and their career choices; investments in physical facilities; and the place of dentistry in research universities. The findings of our study are the following: the number of students per full-time clinical faculty member increased; the three schools with the lowest revenue increases lost a third of their full-time clinical faculty; more students are from wealthier families; most schools are not able to adequately invest in their physical plant; and more than half of schools have substantial NIH-funded research programs. If current trends continue, the term "crisis" will describe the situation faced by most dental schools. Now is the time to build the political consensus needed to develop new and more effective strategies to educate the next generation of American dentists and to keep dental education primarily based in research universities. The future of the dental profession and the oral health of the American people depend on it.

Does faculty development enhance teaching effectiveness?

Academic dentists and members of the practice community have been hearing, for more than a decade, that our educational system is in trouble and that the profession has lost its vision and may be wavering in the achievement of its goals. A core of consistently recommended reforms has framed the discussion of future directions for dental education, but as yet, most schools report little movement toward implementation of these reforms in spite of persistent advocacy. Provision of faculty development related to teaching and assessment strategies is widely perceived to be the essential ingredient in efforts to introduce new curricular approaches and modify the educational environment in academic dentistry. Analyses of the outcomes of efforts to revise health professions curricula have identified the availability and effectiveness of faculty development as a predictor of the success or failure of reform initiatives. This article will address faculty development for purposes of enhancing teaching effectiveness and preparing instructors for potential new roles associated with curriculum changes. Its overall purpose is to provide information and insights about faculty development that may be useful to dental schools in designing professional growth opportunities for their faculty. Seven questions are addressed: 1) What is faculty development? 2) How is faculty development accomplished? 3) Why is faculty development particularly important in dental education? 4) What happens when faculty development does not accompany educational reform? 5) Why are teaching attitudes and behaviors so difficult to change? 6) What outcomes can be expected from faculty development? and 7) What does the available evidence tell us about the design of faculty development programs? Evidence from systematic reviews pertaining to the teaching of evidence-based dentistry, strategies for continuing professional education, and the Best Evidence in Medical Education review of faculty development outcomes are presented to answer this question: does faculty development enhance teaching effectiveness? Characteristics consistently associated with effective faculty development are described.

U.S. dental school applicants and enrollees, 2005 entering class.

There were 10,731 applicants to the entering dental school class in 2005. This represents a 13.8 percent increase over the number of applicants to the 2004 entering class and almost a 45 percent increase over the number of applicants in 2001. Dental schools reported 4,558 first-time, first-year enrollees in 2005, an increase of 101 first-time, first-year enrollees over the number reported in 2004. The percent of applicants that were enrolled in 2005 was 42.5. The percent of applicants enrolled in 2001 was 57.6. Women were 44.2 percent of the applicants and 43.8 percent of the first-time, first-year enrollees in 2005, slight increases from what they were in 2004. Underrepresented minorities comprised 12.8 percent of the applicants and 12.6 percent of the first-time, first-year enrollees in 2005. These percentages are little changed from those reported in 2001. The average GPA of the first-time, first-year enrollees increased slightly in 2005, from 3.4 to 3.5; there was little change in DAT scores, standing at 18.9 for Academic Average, 17.4 for Perceptual Ability, and 18.4 for Total Science.

The dental education environment.

The second in a series of perspectives from the ADEA Commission on Change and Innovation in Dental Education (CCI), this article presents the CCI's view of the dental education environment necessary for effective change. The article states that the CCI's purpose is related to leading and building consensus in the dental community to foster a continuous process of innovative change in the education of general dentists. Principles proposed by CCI to shape the dental education environment are described; these are critical thinking, lifelong learning, humanistic environment, scientific discovery and integration of knowledge, evidence-based oral health care, assessment, faculty development, and the health care team. The article also describes influences external to the academic dental institutions that are important for change and argues that meaningful and long-lasting change must be systemic in nature. The CCI is ADEA's primary means to engage all stakeholders for the purpose of educating lifelong learners to provide evidence-based care to meet the needs of society.

The case for change in dental education.

This article introduces a series of white papers developed by the ADEA Commission on Change and Innovation (CCI) to explore the case for change in dental education. This preamble to the series argues that there is a compelling need for rethinking the approach to dental education in the United States. Three issues facing dental education are explored: 1) the challenging financial environment of higher education, making dental schools very expensive and tuition-intensive for universities to operate and producing high debt levels for students that limit access to education and restrict career choices; 2) the profession's apparent loss of vision for taking care of the oral health needs of all components of society and the resultant potential for marginalization of dentistry as a specialized health care service available only to the affluent; and 3) the nature of dental school education itself, which has been described as convoluted, expensive, and often deeply dissatisfying to its students.

Educational strategies associated with development of problem-solving, critical thinking, and self-directed learning.

This article was developed for the Commission on Change and Innovation in Dental Education (CCI), established by the American Dental Education Association. CCI was created because numerous organizations within organized dentistry and the educational community have initiated studies or proposed modifications to the process of dental education, often working to achieve positive and desirable goals but without coordination or communication. The fundamental mission of CCI is to serve as a focal meeting place where dental educators and administrators, representatives from organized dentistry, the dental licensure community, the Commission on Dental Accreditation, the ADA Council on Dental Education and Licensure, and the Joint Commission on National Dental Examinations can meet and coordinate efforts to improve dental education and the nation's oral health. One of the objectives of the CCI is to provide guidance to dental schools related to curriculum design. In pursuit of that objective, this article summarizes the evidence related to this question: What are educational best practices for helping dental students acquire the capacity to function as an entry-level general dentist or to be a better candidate to begin advanced studies? Three issues are addressed, with special emphasis on the third: 1) What constitutes expertise, and when does an individual become an expert? 2) What are the differences between novice and expert thinking? and 3) What educational best practices can help our students acquire mental capacities associated with expert function, including critical thinking and self-directed learning? The purpose of this review is to provide a benchmark that faculty and academic planners can use to assess the degree to which their curricula include learning experiences associated with development of problem-solving, critical thinking, self-directed learning, and other cognitive skills necessary for dental school graduates to ultimately become expert performers as they develop professionally in the years after graduation.

ADEA survey of clinic fees and revenue: 2003-04 academic year.

The American Dental Education Association's 2003-04 Survey of Clinic Fees and Revenue obtained data by which to report, by school, clinic revenue information per student. Fifty-one of the fifty-four dental schools that had third- and fourth-year students responded to the survey. The median revenue per third-year student was dollar 9,937. It was dollar 13,602 for fourth-year students. Clinic revenue was also obtained for programs of advanced dental education. General Practice Residency programs generated the highest revenue per student at dollar 66,474, followed by programs of Advanced Education in General Dentistry at dollar 63,860. Other areas of the survey provided information regarding clinic fees by type of program, levels of uncompensated care by type of program, clinic revenue by source of payment, and dental school fees as a percent of usual and customary private practice fees.

U.S. State-supported dental schools: financial projections and implications.

This article examines the impact of financial trends in state-supported dental schools on full-time clinical faculty; the diversity of dental students and their career choices; investments in physical facilities; and the place of dentistry in research universities. The findings of our study are the following: the number of students per full-time clinical faculty member increased; the three schools with the lowest revenue increases lost a third of their full-time clinical faculty; more students are from wealthier families; most schools are not able to adequately invest in their physical plant; and more than half of schools have substantial NIH-funded research programs. If current trends continue, the term "crisis" will describe the situation faced by most dental schools. Now is the time to build the political consensus needed to develop new and more effective strategies to educate the next generation of American dentists and to keep dental education primarily based in research universities. The future of the dental profession and the oral health of the American people depend on it.

Dental school vacant budgeted faculty positions: academic year 2004-05.

The number of vacant budgeted faculty positions in dental schools has continued to decline, dropping from 296 in 2003-04 to 275 in 2004-05. The number of lost positions declined to twenty-five, from 147 lost positions reported in 2003-04. While the average number of vacancies per dental school was just under five, three-quarters of these vacancies were considered usual and normal to the operation of the dental school. Based on ADEA's annual survey of dental educators, there was approximately a 9 percent faculty turnover between 2003-04 and 2004-05, and according to the 2003-04 and 2004-05 surveys of vacant faculty positions, it is taking longer to fill vacant positions. The greatest challenges influencing the ability of a school to fill a vacancy were salary/budget limitations and lack of response to a position announcement. Still, between 2003-04 and 2004-05, the number of dental school faculty increased from 11,348 to 11,715, including 4,736 full-time, 5,097 part-time, and 1,791 volunteer faculty members. Employment status was not reported for ninety-one individuals. Private practice remains the primary reason for faculty separations and the source of new faculty. In addition, nearly one in four new faculty members entered dental education directly following graduation from a dental or postdoctoral education program. While it may take longer to fill positions and it has become more difficult to fill some vacancies, overall, dental school deans indicated that the number of vacancies was not affecting the quality of dental education. However, between anticipated faculty retirements and current levels of faculty turnover, continued support for and development of faculty recruitment and retention programs remains essential to maintaining a quality dental education workforce.

Survey of dental student financial assistance, 2003-04.

The Survey of Dental Student Financial Assistance reports data collected by the American Dental Education Association on financial assistance to dental students in the academic year 2003-04. Over 90 percent of students at the fifty-one responding dental schools received financial assistance in the form of loans, grants, scholarships and/or work-study programs, with students receiving an average of 43,191 dollars per year. As tuition and fees rose 21.4 percent over the past two years, financial assistance rose 23.1 percent. Both continue to increase at a rate greater than inflation. The primary source of financial assistance was in the form of loans, accounting for nearly 90 percent of the reported financial assistance. Most of the remaining assistance was in the form of obligated or unobligated grants and scholarships, with an increasing share attributable to grants/scholarships with obligations following graduation. As the price of higher education increases, reliance on financial assistance continues to increase, and students graduate with an increasing amount of debt in real and constant dollars.

U.S. dental school applicants and enrollees: 2003 and 2004.

Following a 25 percent decline in dental school applicants between 1997 and 2001, from 9,829 to 7,412, the number of applicants over the last three years has increased to 9,433. Based on the rate of applicants to the class entering in the fall of 2005, it is estimated there will be a further 10 to 15 percent increase in the number of applicants, thereby exceeding the 1997 number of applicants. The number of first-time, first-year enrollees rose from 4,039 to 4,457 (10.4 percent) between 1996 and 2004, during which time three new dental schools were established (Nova Southeastern University; University of Nevada, Las Vegas; and Arizona School of Dentistry & Oral Health). Almost 54 percent of the 418 additional first-year positions can be attributed to the three new schools. Slightly over 47 percent of the dental school applicants were enrolled in 2004; 55.4 percent of the applicants in 2003 were enrolled. The number of applicants per first-time, first-year position was 2.12 in 2004 and 1.81 in 2003. It was 2.31 in 1997, the last peak of dental school applicants. (The most recent low was 1.34 in 1989.) The average GPA of the first-time, first-year enrollees continued to increase slightly, standing at 3.35 for science GPA and 3.44 for total GPA. Over the last several years there has been essentially no change in the average academic average and total science DAT scores of the first-time, first-year enrollees, standing at 18.7 and 18.5 respectively. However, the average perceptual ability score has declined slightly, from 18.1 to 17.3. Women were 43.9 percent of the applicants and 42.4 percent of the first-time, first-year enrollees in 2004. Five years ago, women were 38.6 percent of the applicants and 36.5 percent of the first-time, first-year enrollees. Underrepresented minorities comprised 12.4 percent of the applicants and 11.6 percent of the first-time, first-year enrollees in 2004. These percentages are little changed from those reported since 2001.

Dental school vacant budgeted faculty positions: academic year 2003-04.

The total number of vacant budgeted positions (296) fell by eleven positions between 2002-03 and 2003-04. However, the reported number of lost positions increased from thirty-nine to 147. The average number of vacancies per school was 5.3. The average number of vacancies reported to be usual and normal at any one time was 3.6 per school, the same as last year. Forty-three percent of the vacancies had been vacant less than seven months, a decline from 55 percent in 2002-03, indicating an increase in the number of positions vacant longer than six months. Meeting position requirements was the most frequently reported factor cited as influencing the ability to fill a position. This is a change from recent previous years when the most influencing factors were salary/budget limitations and lack of response to position announcements. While there was no indication expressed in the survey that vacancies were adversely affecting the quality of dental education, almost 50 percent of the deans reported faculty recruitment and retention was a problem at their school, and over 55 percent indicated that they anticipated it would become more difficult over the next five years to fill vacated positions. Faculty recruitment, development, and retention remain priority issues in meeting the teaching, research, patient care, and administrative needs of the dental education community.

Applicants to U.S. dental schools: an analysis of the 2002 entering class.

In 2002, there were 7,537 applicants to all entering dental school classes in the United States. This represents a 1.7 percent increase over the number of applicants in 2001. Between the peak of applicants in 1997 (at 9,829) and 2001, the number declined 25.0 percent. (This is similar to the percent decline that occurred in medical school applicants since their peak in 1996, at 46,968.) Dental schools reported 4,372 first-time, first-year enrollees in 2002. This is an increase of 105 first-time, first-year enrollees over the number reported in 2001. With the 1.7 percent increase in applicants and the 2.5 percent increase in first-time, first-year enrollees over last year, 58 percent of the dental school applicants were enrolled in 2002. This is up very slightly from 57.6 percent in 2001. Since 1989 when dental school enrollment once again began to increase, the number of first-time, first-year enrollees has increased 17.7 percent. (Total first-year enrollment, which includes first-time enrollees and repeat students, has increased 11.8 percent since 1989.) The number of applicants per first-time, first-year position was 1.72 in 2002. It was 2.31 in 1997. (The most recent low was 1.34 in 1989.) The average GPA and DAT scores of first-time, first-year enrollees in 2002 were essentially unchanged from what they were in 2001. Women were 43.7 percent of the applicants and 42.7 percent of first-time, first-year enrollees in 2002, slight increases from what they were in 2001. Underrepresented minorities comprised 12.8 percent of the applicants and 11.4 percent of the first-time, first-year enrollees in 2002. These percentages are little changed from those reported in 2001.

Dental school vacant budgeted faculty positions, academic year 2002-03.

The number of vacant budgeted full-time faculty positions has changed little over the last three years, standing in 2002-03 at 280. The number of part-time vacancies, though, has continued to decline to twenty-seven. The average number of vacancies per school was 5.7, down from 6.4 of the past several years. The average number of vacancies reported to be usual and normal at any one time was 3.6. Forty-three percent of the schools reported four or fewer vacant budgeted faculty positions in 2002-03. Overall, the order of primary disciplines by their number of vacancies varies from year to year; however, with no particular trend by discipline. Also there does not appear to be any significant correlation between discipline and the length of time a position has been vacant. Fifty-five percent of the vacant positions had been vacant less than seven months. Salary/budget limitations and lack of response to position announcements were the most frequently reported factors influencing the ability to fill a position. There were 921 reported faculty separations in 2002-03. Forty-six percent were a result of faculty leaving for private practice. The number of new faculty reported in 2002-03 was 1,231. Fifty-one percent of the new faculty came from private practice. The total number of faculty reported in 2002-03 was 357 more than reported in 2001-02. Rather than a perceived pending shortage of faculty, it may be more of an endemic number of vacancies due to the amount of time needed to fill a position. While there is no indication expressed in the survey that current vacancies are adversely affecting the quality of dental education, foresight, planning, and necessary steps need to continue to ensure the preparation and continuity of a dental workforce sufficient in size and expertise to meet the teaching, research, patient care, and administrative needs of the dental education community.