Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors.

Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.

Career transition and dental school faculty development program.

Academic dentistry, as a career track, is not attracting sufficient numbers of new recruits to maintain a corps of skilled dental educators. The Faculty Development Program (FDP) at the University of Texas Health Science Center at San Antonio Dental School received federal funds to institute a 7-component program to enhance faculty recruitment and retention and provide training in skills associated with success in academics including:(1) a Teaching Excellence and Academic Skills (TExAS)Fellowship, (2) training in research methodology,evidence-based practice research, and information management, (3) an annual dental hygiene faculty development workshop for dental hygiene faculty, (4) a Teaching Honors Program and Academic Dental Careers Fellowship to cultivate students' interest in educational careers, (5) an Interprofessional Primary Care Rotation,(6) advanced education support toward a master's degree in public health, and (7) a key focus of the entire FDP, an annual Career Transition Workshop to facilitate movement from the practice arena to the educational arm of the profession.The Career Transition Workshop is a cap stone for the FDP; its goal is to build a bridge from practice to academic environment. It will provide guidance for private practice, public health, and military dentists and hygienists considering a career transition into academic dentistry. Topics will be addressed including: academic culture, preparation for the academic environment,academic responsibilities, terms of employment,compensation and benefits, career planning, and job search / interviewing. Instructors for the workshop will include dental school faculty who have transitioned from the practice, military, and public health sectors into dental education.Objectives of the Overall Faculty Development Program:• Provide training in teaching and research skills,career planning, and leadership in order to address faculty shortages in dental schools and under representation of minority faculty.• Provide resident and faculty training in cultural and linguistic competency.• Develop and conduct a collaborative inter professional education project with a Pediatric Medicine department, a nursing school, and other health professions' education programs.• Provide faculty and residents with financial support to pursue a master's degree in public health; and • Provide support and assistance for dental practitioners desiring to explore a transition into the educational environment.

An interprofessional education initiative: Introducing a local anesthesia dental course for nurse practitioner and physician assistant students.

PURPOSE/OBJECTIVE: To assess the impact of local anesthesia (LA) course for physician assistant (PA) and adult gerontology-acute care nurse practitioner (NP) program students on knowledge, attitudes, confidence, and intention to incorporate skills in clinical practice. METHODS: The course was conducted by dental faculty for forty-eight PA and seven NP students and consisted of two lecture hours on anatomy of the oral cavity, anesthesia and pain management, 2 hours of preclinic lab where participants practiced injection technique on mannikins, and a clinical practicum conducted by dental school faculty and residents where students observed dental treatment including administration of LA, and discussed symptom triage by NPs and PAs for patients with dental problems including orofacial pain, initial management including LA, and patient referral to dentists. An online survey was administered to all students before and after the course to assess changes in knowledge, attitudes, confidence, and intention to incorporate LA administration skills into clinical practice and elicit students' perception of program quality. Pre- to post-changes were analyzed by two-tailed t-tests and analysis of variance (ANOVA) with significance at 0.05. RESULTS: The response rate for pre- and post-course assessment was 96.4% and 87.3% respectively. Students' overall scale score for self-assessment of dental knowledge increased significantly from pre- (2.34) to post-assessment (4.19). An increase was seen in students' attitudes regarding management of dental emergencies (t = 2.181; p < 0.05). Furthermore, overall confidence of students related to managing patients with dental problems increased significantly (2.00 to 3.85) after taking the course. CONCLUSION: The LA course was well received by PA and NP students and resulted in increased knowledge and confidence in recognizing common oral health conditions, understanding dental pain management including administration of LA, and making referrals to dentists to optimize patient care.

Pilot test of an emerging leaders program for dental school faculty.

PURPOSE/OBJECTIVES: The School of Dentistry at The University of Texas Health Science Center at San Antonio (UTHSA-SoD) implemented an SoD Emerging Leaders Program (SoDELP) in 2020-2021. This case report describes the leadership training needs of junior faculty that stimulated SoDELP development, the inter-institutional collaboration that facilitated program implementation, SoDELP curriculum content, and outcomes of formative assessment for two pilot cohorts of the SoDELP. METHODS: The 32-h curriculum was comprised of readings, reflection exercises, seminars by the Center for Professional Excellence at the University of Texas at San Antonio, case discussion, analysis of leadership dilemmas, and self-assessments. For a capstone project, participants created a case depicting a challenging leadership situation they experienced as a team leader or member. The SoDELP commenced in a face-to-face format but was completed online due to COVID 19. Formative evaluation included participants' pre- and post-training perceptions elicited by the Leadership Attitudes, Confidence and Concerns Inventory (LACCI) and qualitative appraisal of program components obtained by surveys and focus groups. RESULTS: All 18 participants completed SoDELP and provided positive evaluations of program content, organization, teaching quality, and value. Analysis of pre- and post-assessments indicated that participants' confidence in performing an array of leadership tasks was significantly enhanced, and participants' concerns about assuming leadership roles, such as not being ready for the job, impact on friendships, or concerns about ethical challenges, were significantly reduced. The LACCI displayed promising reliability in assessing participants' confidence, attitudes and concerns, demonstrating the potential to serve as a measurement tool to appraise outcomes of leadership training in the health professions. CONCLUSION: Outcomes suggest that SoDELP enhances faculty members' sense of readiness for leadership roles, and the LACCI may be a useful assessment tool for leadership training.

Teaching evidence-based practice at the University of Texas Health Science Center at San Antonio dental school.

The overarching goal of the Evidence-Based Practice Program at San Antonio is to provide our graduates with life-long learning skills that will enable them to keep up-to-date and equip them with the best possible patient care skills during their 30-40 years of practice. Students are taught to (1) ask focused clinical questions, (2) search the biomedical research literature (PubMed) for the most recent and highest level of evidence, (3) critically evaluate the evidence, and (4) make clinical judgments about the applicability of the evidence for their patients. Students must demonstrate competency with these "just-in-time" learning skills through writing concise one-page Critically Appraised Topics (CATs) on focused clinical questions. The school has established an online searchable library of these Critically Appraised Topics. This library provides students and faculty with rapid, up-to-date evidence-based answers to clinical questions. The long-range plan is to make this online library available to practitioners and the public.

The San Antonio CATs Initiative.

There is evidence from medicine that schools and practitioners are slow to adopt new and proven effective treatments while marketing efforts lead practitioners to too quickly adopt unproven modalities. To address these problems, the dental school at the University of Texas Health Sciences Center at San Antonio, has developed a program designed to teach students, faculty, and practitioners the skills of accessing the literature as an intrinsic part of treatment. The Critically Appraised Topics (CATs) program is described and evidence is presented showing that participants can be taught to prepare high-quality summaries of the literature pertinent to clinical problems.

Chanqes in dental school curricula, 2003-2009.

This 2009 study of dental school curricula follows a similar one conducted in 2002-2003. Through a Web-based survey, the authors gathered information from dental schools about: (a) trends in curricular change over seven years; (b) changes underway in dental school curricula; (c) significant challenges to curricular innovation; and (d) projected trends in curricular change and innovation. In a significant change from the 2002-2003 study, a high proportion (91%) of the responding schools require community-based patient care by all students, with just over one-half ot them requiring five or more weeks of such experience. Respondents reported that priorities for future curriculum modification included: creating interdisciplinary curricula that are organized around themes, blending the basic and clinical sciences, provision of some elements of core curriculum in an online format, developing new techniques for assessing competency, and increasing collaborations with other health professions schools. Respondents identified training for new faculty members in teaching skills, curriculum design, and assessment methods as the most critical need to support future innovation.

Case Report of a Program to Enhance Dental Students' Interest in Academic Dentistry.

This case report describes a Teaching Honors Program (THP) at the UT Health San Antonio School of Dentistry and presents findings from an outcomes assessment covering the initial 11 years of the program. The program goals are to enhance dental students' awareness of academic career options, promote student and faculty collaboration on educational development projects, and provide students with training in teacher toolkit skills to increase their readiness for peer teaching during dental school and faculty roles early in their careers. The THP curriculum consists of six core courses and nine electives extending across the four years of dental school. THP graduates receive the academic designation "Distinction in Dental Education" at commencement. Outcomes data are organized by Kirkpatrick's Hierarchy of Educational Outcomes: reaction (participants' satisfaction with THP), indicators (students' attitudes and intentions pertinent to teaching and academic careers), learning (changes in knowledge and skills relevant to teachers' tasks), behavior (students' ability to apply teaching skills in classrooms, labs, and clinics), and results (changes in the infrastructure and capacity of the school as a consequence of the THP). Positive outcomes were found in multiple layers of the assessment hierarchy. In 2016, 51% of students participated in the THP, and 31 graduated with Distinction in Dental Education; in 2017, 50% participated, and 44 graduated with that honor. THP students provide approximately 1,400 hours of supervised peer teaching annually in the predoctoral curriculum and pre-matriculation programs, and 21% of the initial 106 THP graduates entered academic dentistry soon after graduation.

Online Case-Sharing to Enhance Dental Students' Clinical Education: A Pilot Study.

Dental students' clinical learning is dictated by patients' needs. Thus, not all students have identical educational experiences. Even routine treatment can require different approaches depending on concurrent dental problems, patients' health status, or unexpected complications. No curriculum can expose students to all treatment alternatives when issues arise. Consequently, mechanisms to facilitate students' learning from the collective experiences of their classmates can augment their clinical acumen. The aim of this pilot study was to investigate a blended learning experience consisting of a website on which third- and fourth-year students posted and discussed PowerPoint presentations depicting patient treatment and weekly seminars in which students and faculty discussed posted cases to retrospectively assess treatment decisions. All 49 students in two of the school's general practice groups (23 fourth-year and 26 third-year students) in academic year 2011-12 participated, using a PowerPoint template to create cases to share with their peers. The students completed the Clinical Education Instructional Quality Inventory (Clin-EdIQ) before and after the case-sharing experience. The results showed statistically significant pre- to posttest increases on the four ClinEdIQ dimensions: overall clinical learning experience, specific learning opportunities, interaction among students and instructors, and collaborative learning. These students also reported that the online case-sharing and follow-up seminars were a valuable educational experience. However, students not involved in case-sharing had similar pre to post ClinEdIQ score changes. The results suggest that online case-sharing supported by case analysis seminars facilitated exchange of clinical insight among students and instructors, but may not have altered students' perceptions of the clinical learning environment.

The quality of dental faculty work-life: report on the 2007 dental school faculty work environment survey.

This report is the third in a series of articles on the dental school work environment commissioned by the American Dental Education Association's Commission on Change and Innovation in Dental Education. The report is based on the most extensive research to date on faculty satisfaction in the dental school environment. The purpose of the study was to assess faculty perceptions and recommendations related to work environment, sources of job satisfaction and dissatisfaction, and professional development needs. More broadly, the study intends to provide insight into the "change readiness" of dental schools to move forward with curricular improvements and innovations. Findings are based on 1,748 responses from forty-nine U.S. dental schools obtained during the time frame of February to April 2007. The total number of respondents constituted 17 percent of all U.S. dental school faculty. The average response rate per school was thirty-six (21 percent). To elucidate the data in terms of issues related to the quality of faculty work-life based on demographics, the authors compared perceptions of various aspects of the work culture in academic dentistry among faculty with different academic ranks and academic degrees and by other variables such as age and gender, tenure versus non-tenure appointments, and full- versus part-time status. Quantitative and qualitative analyses show that the majority of faculty members described themselves as very satisfied to satisfied with their dental school overall and with their department as a place to work. Tenured associate professors expressed the greatest level of dissatisfaction. Opportunities for and support of professional development emerged as an area requiring substantially more attention from dental schools. The authors of the study suggest that dental school leaders use these findings to assess their individual dental school's work environment and to plan changes as needed.

Assessing dental students' competence: best practice recommendations in the performance assessment literature and investigation of current practices in predoctoral dental education.

In this article, the Task Force on Student Outcomes Assessment of the American Dental Education Association's Commission on Change and Innovation in Dental Education describes the current status of student outcomes assessment in U.S. dental education. This review is divided into six sections. The first summarizes the literature on assessment of dental students' performance. Section two discusses catalysts, with a focus on problem-based learning, for development of new assessment methods, while the third section presents several resources and guides that can be used to inform selection of assessment techniques for various domains of competence. The fourth section describes the methodology and results of a 2008 survey of current assessment practices in U.S. dental schools. In the fifth section, findings from this survey are discussed within the context of competency-based education, the educational model for the predoctoral curriculum endorsed by the American Dental Education Association and prescribed by the Commission on Dental Accreditation. The article concludes with a summary of assessments recommended as optimal strategies to measure three components of professional competence based on the triangulation model. The survey of assessment practices in predoctoral education was completed by 931 course directors, representing 45 percent of course directors nationwide, from fifty-three of the fifty-six U.S. dental schools. Survey findings indicate that five traditional mainstays of student performance evaluation-multiple-choice testing, lab practicals, daily grades, clinical competency exams, and procedural requirements-still comprise the primary assessment tools in dental education. The survey revealed that a group of newer assessment techniques, although frequently identified as best practices in the literature and commonly used in other areas of health professions education, are rarely employed in predoctoral dental education.

Critical Thinking in Dental Students and Experienced Practitioners Assessed by the Health Sciences Reasoning Test.

To date, there has been a lack of published studies examining the validity of the Health Sciences Reasoning Test (HSRT) to assess critical thinking among dental students. The aim of this study was to examine the construct validity of the HSRT using a novice-expert model consisting of first-year dental students as novices and experienced general dentists as experts. Novice cohort subjects were recruited from all 105 students in the first-year dental school class at the University of Texas Health Science Center at San Antonio during a regularly scheduled course in August 2015. A total of 83 students participated, for a 79% response rate. Thirty individuals personally recruited from the same school's faculty and from private practitioners made up the expert cohort. The results showed that the adjusted mean overall score for the expert cohort (25.31) was significantly higher than that of the novice cohort (22.64) (p=0.04). The expert cohort achieved higher adjusted mean scores in all scales (Induction, Deduction, Analysis, Inference, and Evaluation), with the difference in the Analysis scale being significant (p=0.02). In this study, experienced general dentists achieved significantly better overall scores on the HSRT as compared to first-year dental students, suggesting the instrument was able to measure differences between novice and expert. Further efforts to validate the instrument in a dental education setting and to understand its correlation with strategies and practices aimed at developing critical thinking in dental students are warranted.

In the students' own words: what are the strengths and weaknesses of the dental school curriculum?

Dental students have little input into the selection of course topics and subject matter included in their dental curricula. Curriculum requirements are framed by the Commission on Dental Accreditation, which has stipulated competencies and associated biomedical and clinical knowledge that must be addressed during dental school. Although these competency requirements restrict the variance of educational experiences, students are eager to share their views on the curriculum within the realm of their educational experience. The objective of this research project was to elicit the perspectives of dental students from a broad cross-section of U.S. and Canadian dental schools about their education. A total of 605 students (285 sophomores, 220 seniors, 100 residents) from twenty North American dental schools completed a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis to communicate their perceptions of the curriculum. Students were also asked to provide their impressions of the overall quality of the educational program in an open-ended written format. The students' qualitative comments were then reviewed and categorized into key issues or themes. Resulting themes for each category of the Curriculum SWOT (C-SWOT) analysis were the following. Strengths: 1) clinical learning experience, and 2) opportunity to work with knowledgeable faculty. Weaknesses: 1) disorganized and inefficient clinical learning environment, 2) teaching and testing that focus on memorization, 3) poor quality instruction characterized by curricular disorganization, and 4) inconsistency among instructors during student evaluations. Opportunities: 1) develop strategies to provide students with more exposure to patients, especially early in the curriculum, and 2) opportunities to learn new technology/techniques. Threats: 1) cost of dental education, 2) students' concerns about faculty "brain drain," i.e., lack of sufficient numbers of dental faculty capable of providing high-quality instruction, and 3) questionable treatment of patients in the dental clinic as a consequence of pursuing procedural requirements. This report presents commentaries selected from 2,421 total responses that communicate students' perspectives related to C-SWOT themes. Students at seven schools in this study reported that they completed all or portions of the first two years of the curriculum in combined classes with medical students. Sophomore and senior students at these schools provided their thoughts on this curricular approach; these perceptions are also reported. Findings from this study are compared to results from a similar investigation of dental student perceptions conducted fifty years ago. We conclude that students participating in this study were positive overall about their learning experiences in dental schools, but identified several areas that appear to be problematic for many students at a variety of different schools including fundamental concerns about instructional quality in some areas of the curriculum. Academic program administrators in dental schools can use these findings to guide modifications that will enhance the overall dental education experience.

Does the dental school work environment promote successful academic careers?

A consistent theme in the national dialogue about future directions for the educational arm of dentistry is how best to cultivate a school environment that will be seen as attractive by members of the dental community who desire to serve their profession as teachers and scholars. As a first step toward stimulating broad-based reflection on the working environment within dental schools, the ADEA Commission on Change and Innovation (CCI) conducted a symposium titled "Change, Innovation, and the Quality of Faculty Work-Life" at the 2007 ADEA Annual Session in New Orleans. Aspects of this article are based on the content of this symposium, which explored research on the perceptions and concerns of dental faculty regarding the current academic workplace and provided perspectives of university faculty about university life and career growth. This article reviews the findings from two interview-based qualitative assessments of faculty perceptions of work-life in dental schools and other schools of higher education, presents a preliminary summary of the first national survey of dental school faculty regarding their impressions of the academic work environment, and makes recommendations for enhancing the dental school work environment with an emphasis on those factors that influence career growth. Results from these three studies illustrate faculty perceptions about the promotion and tenure and performance evaluation processes; workload and quality of work-life; and quality of institutional support.

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.

Is Dental Students' Clinical Productivity Associated with Their Personality Profile?

The aim of this study was to assess the relationship between personality preferences of incoming fourth-year dental students at the University of Texas Health Science Center at San Antonio as measured by the Keirsey Temperament Sorter II and their third-year clinical productivity and percentage of broken appointments. All 105 incoming fourth-year dental students in 2016 were invited to participate in the study, and 92 students completed the temperament questionnaire, for a response rate of 87.5%. Those students' clinical activity during their third year was measured by production points and percentage of broken appointments extracted from the electronic health record. The results showed that the majority of the respondents were extroverts rather than introverts and that the extroverts had significantly higher production points and significantly fewer broken appointments than the introverts. The most common personality preferences were sensing and judging. More than two-thirds of the respondents represented the Guardian temperament, one of four categories on the temperament measure. These findings help highlight the traits that may contribute to success in clinical training during dental school and support the notion that clinical success may be influenced by certain personality characteristics as well as the technical and specialized skills of dentistry.

North American dental students' perspectives about their clinical education.

Many North American dental schools face the challenge of replacing the majority of their "boomer generation" clinical instructors over the next ten years as this cohort of faculty reaches retirement age. Developing a new cadre of clinical instructors poses a substantial faculty development challenge: what instructional techniques should be integrated into routine educational practice by the dental faculty of the future, and what aspects of the clinical learning environment should be addressed to improve the overall quality of the experience for patients, students, and the new cohort of instructors? To gain insight that might guide faculty development for new clinical instructors and enhance understanding of the learning environment in dental school clinics, this study addressed the following question: what are dental students' perceptions of their learning experiences in the clinical setting? The purpose of the study was to evaluate the effectiveness of the clinical instruction from the perspectives of the actual "consumer" of dental education: the student. This consumers' perspective was provided by 655 junior, senior, and graduate dental students at twenty-one North American dental schools who completed the Clinical Education Instructional Quality Questionnaire (ClinEd IQ) in 2003-04. The ClinED IQ examines four components of students' clinical experiences: 1) clinical learning opportunities, 2) involvement in specific learning activities, 3) interaction with clinical instructors, and 4) personal perceptions about clinical education. With the exception of inconsistent feedback and instruction and lack of continuous contact with the same instructors, juniors, seniors, and graduate students rated their interaction with clinical instructors favorably (mean=4.76 on a 6.00 scale), but provided lower ratings for clinical learning opportunities (mean=4.26 on a 6.00 scale) due to concerns about the efficiency of the dental clinic environment and lack of opportunity to treat patients in a variety of clinical settings. Analysis of more than 1,000 written comments provided by these students indicated four areas of concern: 1) inconsistent and sometimes insensitive (patronizing, rude) feedback from faculty; 2) excessive amounts of noneducational "legwork" such as billing, patient scheduling, phone calling, completing paperwork, and performing other clinic operations tasks; 3) limited access to faculty because of insufficient numbers of instructors on the clinic floor or difficulty locating faculty when they were needed for coaching, work evaluation, and chart signatures; and 4) concerns about the strategies employed to meet procedural requirements that some students saw as ethically questionable. Junior, senior, and graduate dental students at twenty-one North American dental schools perceived that the strongest aspect of their clinical education was their relationship with the faculty, but also reported that the dental school clinic was often an inefficient learning environment that hindered their opportunity to develop clinical competency. Students also sensed that faculty shortages, a growing crisis for dental education, hindered their progress in the clinic and made learning less efficient.

What do dental students think about mandatory laptop programs?

In spite of efforts by many dental schools to provide information technology resources for students, only a handful of studies have been conducted to determine what dental students think about these initiatives. There are no reports in the literature describing students' perceptions of mandatory laptop programs, which are now being implemented by at least 25 percent of North American dental schools. In schools that have implemented laptop programs, students are required either to enroll with their own laptops that meet specifications or to purchase a laptop from the school at matriculation. In some schools, students are also required to purchase curriculum support software that is bundled with the laptop. This study was conducted to determine students' opinions at U.S. dental schools with mandatory laptop programs about these aspects of this information technology initiative: frequency of use, perceived necessity of use, note-typing during lectures, effectiveness of training, influence on study habits, benefits, implementation problems, added value in relation to added tuition costs, impact on quality of dental education, overall rating of the laptop experience, and impact of the laptop on use of other electronic curriculum resources. Responses of students at schools that purchased packaged curriculum support software from a commercial vendor were compared with students' responses at schools where faculty provided their own educational software. Responses were also compared among freshmen, sophomores, and upperclassmen in a cross-sectional sample. In 2004, approximately 800 dental students at fourteen dental schools responded to eleven questions that requested their impressions and evaluation of mandatory laptop programs and associated educational software. These questions comprised one section of the IREC Students' Questionnaire (IREC=Institutional Readiness for Electronic Curriculum) that assessed students' perceptions of various aspects of information technology at their schools. The majority of students (63 percent) reported that the laptop and associated software were not essential for successful performance in their courses primarily because few instructors had modified their courses to take advantage of laptop capacities. Slightly more than half of the students reported their training was good or excellent, but felt that classroom-based "one size fits all" training was not effective. Less than 15 percent of the students reported that they had made substantial changes in their study habits as a consequence of the laptop program. The benefits perceived by students were primarily related to enhanced email communication with classmates and instructors and convenient access to the Internet and teachers' PowerPoint presentations. Implementation barriers included the inconvenience of carrying laptops to classes, lack of incentive to use the laptop and software because instructors did not require it, and poor quality software. Only 32 percent of students agreed that the value of the laptop and associated software was equal to the added tuition costs. Less than half of the students perceived that the laptop and software had improved the quality of their education, but more than 70 percent rated their overall experiences with laptops as "okay," "good," or "excellent." Freshmen expressed significantly more positive attitudes about the frequency of use, cost-effectiveness, educational value, and overall quality of laptops and bundled software than did upperclassmen. A significantly higher percentage of students at schools affiliated with a software vendor reported that laptops were essential in courses than students at schools with locally produced software, but students at vendor-supplied schools rated the cost-effectiveness significantly lower. Overall, students' assessment of mandatory laptop programs was mixed although freshmen provided significantly more positive responses than did upperclassmen. Incorporation of the e-curriculum into dental schools appears to be following a similar pattern as problem-based learning (PBL) in the 1980s and 1990s. Recommendations for enhancing future e-curricula are proposed based on lessons learned from both information technology and PBL implementation.

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.