Can I be a student again? How medical graduates make the decision to return to dental school prior to a career in oral and maxillofacial surgery.

INTRODUCTION: Oral and maxillofacial surgery (OMFS) trainees in the UK have traditionally completed their dental undergraduate studies prior to returning to medical school. Recently, there have been increasing numbers of medical graduates who return to dental school before embarking on OMFS specialist training. There is limited research into the career motivation within this group and little guidance on how they may integrate the dental undergraduate course into their postgraduate training path. This study aims to evaluate these factors in more detail. METHODS: Questionnaires and focus groups were used to evaluate prior surgical experience of qualified medics who return to dental school with the intention of pursuing a career in OMFS, along with the factors that affect the timing of their return to dental school. RESULTS: The average age of medical graduates entering dental school decreased during the study period. The average number of months each cohort of students spent as a practicing doctor prior to starting dentistry also reduced. Postgraduate experience in OMFS was highly variable, but the numbers of students who received alternative exposure to OMFS, such as undergraduate special study modules, medical school elective or taster weeks, increased. The key barriers that were carefully considered by these trainees before returning to university included the perceived increase in the length of training, trainees' prior surgical experience, financial implications and the impact on quality of life. CONCLUSIONS: A trainee's decision to return to study dentistry is a multifactorial process. Understanding when trainees decide to return to sit their dental degree is vital not only to provide guidance for future trainees but also to assist future workforce planning, thus aiding training, education and development within OMFS.

Where do we go from here? Northcroft Memorial Lecture 2010.

The article aims to identify some of the challenges for future training of orthodontics and subsequently the delivery of orthodontic care. Clearly, in any aspect of future prediction, the precision is simply that of an art. However, it is hoped that some of the reported bibliography will allow those that wish to, the opportunity to look further. The global economy is undergoing a significant period of rationalization and luxury items such as Orthodontics may become less publicly funded. In order to maintain the specialty as one in which clinicians are appropriately trained, there needs to be a reconsideration of the way in which education is delivered and assessment assured. This presentation will identify possible challenges and identify a strategy to consider, construct and deliver a rational way forward in a positive way that ensures that the strengths of how the profession has developed are maintained.

Ten-year survey of program directors: trends, challenges, and mentoring in prosthodontics. Part 1.

PURPOSE: This study consisted of two parts. Part 1 was a survey of US program directors, and Part 2 reports on the survey findings distributed to the deans of US dental schools. Both surveys evaluated observations of trends in prosthodontic education. The first survey (2005) of program directors and deans was published in 2007. This second survey was conducted in 2009. The 2009 survey provided 10-year data on trends in prosthodontics as reported by program directors. MATERIALS AND METHODS: A national e-mail survey of 46 program directors was used to collect enrollment data for years 1 to 3 of prosthodontics training for US and international dental school graduates, the total number of applicants and applications considered, and the trends over time of applicants to prosthodontics for US dental school graduates and for international graduates. In addition, the program directors were asked to rank 13 key factors that may have contributed to any changes in the prosthodontic applicant pool. Program directors were also asked for information on student financial incentives and whether their programs were state or federally funded, and whether their sponsoring institution was a dental school. RESULTS: Of the 46 program directors, 40 responded, for an 87% response rate. Respondents reported that 66% of their enrollees were graduates of US dental schools. Between 2000 and 2009 the applicant pool in prosthodontics nearly doubled, with 50% of the program directors reporting an increase in US-trained applicants, 42.5% reporting no change, and only 7.5% reporting a decrease. Using the Spearman correlation for the 10-year survey, there was a positive, statistically significant correlation that society's demand for a higher level of training and credentialing and interest in prosthodontics among dental students contributed to an increase in the number of US dental graduates applying to prosthodontic programs. Only four programs offered no financial packages to offset tuition. The remaining 36 respondents reported some financial package. Among the respondents, there were 23 state-sponsored programs and 6 sponsored by private universities; the remaining 9 were sponsored by hospitals or federal agencies. CONCLUSIONS: A nearly doubled applicant pool and more US-trained applicants to prosthodontics ensure a much more competitive applicant pool for our specialty. In the 2009 survey, program directors reported that factors such as society's demand for a higher level of training and credentialing, interest in prosthodontics among US dental students, advances in implant, esthetic, and reconstructive dentistry, literature pertaining to the need of prosthodontists for the future, marketing of prosthodontics as a career, and the dollar value of prosthodontic training have all had some impact on increasing the mentored applicant pool to prosthodontic training in the United States.

Medicare Support for Dental and Podiatry Graduate Medical Education Programs.

Importance: Oral health care faces ongoing workforce challenges that affect patient access and outcomes. While the Medicare program provides an estimated $14.6 billion annually in graduate medical education (GME) payments to teaching hospitals, including explicit support for dental and podiatry programs, little is known about the level or distribution of this public investment in the oral health and podiatry workforce. Objective: To examine Medicare GME payments to teaching hospitals for dental and podiatry residents from 1998 to 2018, as well as the distribution of federal support among states, territories, and the District of Columbia. Design, Setting, and Participants: This cross-sectional study was conducted using data from 1252 US teaching hospitals. Data were analyzed from May through August 2020. Exposures: Dental and podiatry residency training. Main Outcomes and Measures: Medicare dental and podiatry GME payments were examined. Results: Among 1252 teaching hospitals, Medicare provided nearly $730 million in dental and podiatry GME payments in 2018. From 1998 to 2018, the number of residents supported more than doubled, increasing from 2340 residents to 4856 residents, for a 2.1-fold increase, while Medicare payments for dental and podiatry GME increased from $279 950 531 to $729 277 090, for a 2.6-fold increase. In 2018, an estimated 3504 of 4856 supported positions (72.2%) were dental. Medicare GME payments varied widely among states, territories, and the District of Columbia, with per capita payments by state, territory, and district population ranging from $0.05 in Puerto Rico to $14.24 in New York, while 6 states received no support for dental or podiatry residency programs. Conclusions and Relevance: These findings suggest that dental and podiatry GME represents a substantial public investment, and deliberate policy decisions are needed to target this nearly $730 million and growing investment to address the nation's priority oral and podiatry health needs.

Interest in Dental Hygiene Therapy: a study of dental hygienists in Maine.

Purpose: The purpose of this study was to assess the awareness of registered dental hygienists (RDHs), licensed in the state of Maine, regarding the midlevel dental hygiene therapist (DHT) provider model and to gather data regarding the degree of interest in enrolling in a DHT program.Methods: A quantitative cross-sectional study design with a non-probability purposive sampling of actively practicing RDHs in the state of Maine (n=1,284) was utilized for the web-based survey. Survey questions included awareness in the passage of DHT legislation, level of interest pursuing education and licensure in this midlevel provider model. Data was collected over a three-week period. Descriptive statistics and thematic analysis were used for data analysis.Results: Response rate was 21% (n=268). Sixty-five percent of respondents expressed interest in enrolling in a DHT program and 40% of those respondents stated a willingness to enroll in a DHT program within the coming year. Although willing to travel 25-50 miles, a majority of respondents preferred programs incorporating online components combined with clinical training completed in nearby communities. Themes emerging from the open-ended question regarding DHT program feasibility and appeal included: convenience, flexibility, cost/affordability, and independent or collaborative practice.Conclusion: Study outcomes indicated interest exists among Maine RDHs regarding the DHT provider role and enrollment in a DHT program. Although there are no DHT programs currently being offered in the New England states, results suggest further investigation is warranted regarding the development of a DHT program in the Northeastern United States.

Medicare program; hospital direct and indirect graduate medical education policy changes; notice. Final rule; clarification.

This notice clarifies the availability of certain physician salary proxy data for purposes of the hospital direct and indirect graduate medical education policy adopted in the "Medicare Program; Prospective Payment System for Long-Term Care Hospitals RY 2008: Annual Payment Rate Updates, and Policy Changes; and Hospital Direct and Indirect Graduate Medical Education Policy Changes" final rule that appeared in the May 11, 2007 Federal Register.

Current Status of Postdoctoral and Graduate Programs in Dentistry.

Advanced dental education has evolved in the context of societal needs and economic trends to its current status. Graduate programs have positioned their role in the context of health systems and health science education trends in hospitals, interprofessional clinical care teams, and dental schools and oral health care systems. Graduate dental education has been a critical factor in developing teams in trauma care, craniofacial disorders, pediatric and adult medicine, and oncology. The misalignment of the mission of graduate dental programs and the demands of private practice has posed a challenge in the evolution of programs as educational programs have been directed towards tertiary and indigent care while the practice community focuses on largely healthy affluent patients for complex clinical interventions. Those seeking graduate dental education today are smaller in number and include more international dental graduates than in the past. Graduate dental education in general dentistry and in the nine recognized dental specialties now includes Commission on Dental Accreditation (CODA) recognition of training standards as part of its accreditation process and a CODA accreditation process for areas of clinical education not recognized as specialties by the American Dental Association. Current types of programs include fellowship training for students in recognized specialties. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Factors Influencing Dental Students' Interest in Advanced Periodontal Education: Perspectives of Department Chairs.

The number of graduates of U.S. dental schools enrolled in U.S. postdoctoral programs in periodontics has been decreasing. The aims of this study were to determine the perspectives of periodontics department chairs regarding 1) features of a school's predoctoral curriculum that promote student interest in advanced periodontal education and 2) characteristics of a periodontal residency program that make it more attractive to dental students over other specialty programs. In 2015, a 14-question survey was designed and sent to chairs of periodontics departments at all 65 U.S. dental schools at the time. Questions addressed number of instructional hours; specialty clinic rotations; elective courses; number of applicants to periodontal residency; existence of a residency program; length of the residency program; and externships, fellowships, and financial stipends offered. The survey response rate was 73.8%. The results showed that departments offering more than seven clinical credit hours in periodontics to predoctoral students had the greatest number of residency applicants. Most of the applicants were from institutions that offered specialty clinic rotations, elective courses, and residency programs in periodontics. The number of applicants did not change significantly if a stipend or fellowship was offered. However, the availability of an externship was significantly associated with a greater number of applicants (p=0.042). These results suggest that offering periodontal clinical rotations, elective courses, and especially externships in periodontics during predoctoral education may encourage more graduating students to pursue postdoctoral periodontal education.

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.

Cost of training in oral and maxillofacial surgery: beyond the second degree.

Training in oral and maxillofacial surgery (OMFS) involves considerable personal expense, a long period of training and the need for two degrees. Other costs have also increased, with little change in pay and poor access to funding. After a Freedom of Information request and having reviewed available data, we have established the cost of training in OMFS. There is considerable regional variation in access to funding, with escalating fees for conferences and courses. Recent changes have failed to address these.

Private practice and the economic rate of return for residency training as a prosthodontist.

BACKGROUND: The authors used survey data to estimate the economic rate of return from undertaking an investment in residency training to become a practicing prosthodontist. METHODS: The authors estimated earnings of practicing prosthodontists using results from a survey of 2500 U.S. prosthodontists. Survey data were used to assess the total costs of prosthodontic residency and earnings of practicing general practitioners. The authors applied statistical methods to estimate the internal rate of return (IRR) for prosthodontic residency training. RESULTS: The estimated IRR ranged from 8.23 percent for private practitioners with no financial assistance during residency training to 12.18 percent for full-time private practitioners with stipends and loans. Total costs of residency ranged from 271,835 dollars to 441,321 dollars, depending on the amount of forgone earnings, time in practice and how soon practice began after the residency. CONCLUSIONS: All of the estimates of IRR in this study were positive, indicating that prosthodontic residency is a financially attractive investment. PRACTICE IMPLICATIONS: The positive IRR for prosthodontic residency indicates that the demand for advanced education in prosthodontics will continue, and that the amount of time spent in practice increases the rate of return.

Dental students' perceptions of and experiences with prosthodontics: ten graduating classes at one institution.

It is important for members of the dental specialties to understand what motivates students to enter the specialty in order to ensure its continuing development and ability to meet patient needs. The aim of this study was to compare ten graduating classes at Harvard School of Dental Medicine (HSDM) regarding students' experiences with and perceptions of prosthodontics and factors influencing those interested in pursuing prosthodontics as a specialty. In 2013, HSDM students in the classes of 2012-16 were surveyed, achieving a response rate of 81%. Survey questions sought information regarding specialty choice, factors influencing the choice, student experiences with prosthodontics, and student perceptions of the dental disciplines. Responses were compared to those from a prior study of the HSDM classes of 2007-11. The responses showed a decrease in negative student experiences with prosthodontics. The students regarded prosthodontics highly for its impact on patient quality of life; however, students interested in pursuing prosthodontics as a specialty decreased. All students said provider enjoyment was most important in choice of specialty. Cost of program, patient type, and program location were factors that especially influenced students interested in prosthodontics. The improved student experiences with and perspectives on prosthodontics may be a result of a curriculum change that led to more prosthodontics procedures and case completions by students. The fall in students interested in prosthodontics may have resulted from prosthodontic faculty transitions that occurred when the survey was conducted, as well as large debt burdens in spite of the fact that prosthodontists' earnings are among the highest in dentistry. Faculty must educate and mentor students about the realities of the profession, provide positive learning experiences in the field, and encourage students who enjoy prosthodontics to pursue specialty training.

Factors influencing dental students' specialty choice: a survey of ten graduating classes at one institution.

The aim of this study was to survey ten graduating classes at Harvard School of Dental Medicine regarding students' specialty choice and factors influencing that choice. Students were surveyed once in 2008 (for the Classes of 2007-11) and again in 2013 (for the Classes of 2012-16). A prior article reported results regarding students' interest in and experiences with prosthodontics; this article presents results regarding their interest in all dental specialties and factors influencing those interests. Of a total 176 students in the Classes of 2012-16, 143 responded to the survey, for a response rate of 81%, compared to a 95% response rate (167 of total 176 students) for the Classes of 2007-11. The results showed that orthodontics was the most popular specialty choice, followed by oral and maxillofacial surgery. From the 2008 to the 2013 survey groups, there was an increase in the percentages of students planning to pursue oral and maxillofacial surgery, pediatric dentistry, and postdoctoral general dentistry. The educational debt these students expected to accrue by graduation also increased. The largest percentage of students chose "enjoyment of providing the specialty service" as the factor most influencing their specialty choice. "Prior dental school experience" and "faculty influence" were greater influences for students pursuing specialties than those pursuing postdoctoral general dentistry. Increased interest in particular disciplines may be driven by high debt burdens students face upon graduation. Factors related to mentoring especially influenced students pursuing specialties, demonstrating the importance of student experiences outside direct patient care for exposure to the work of specialists beyond the scope of predoctoral training. This finding suggests that dental schools should increase mentoring efforts to help students make career decisions based not on financial burden but rather on personal interest in the specialty, which is likely to have a more satisfying result for them in the long run.

Background, training experiences, and career plans of U.S. periodontal residents: report of a web-based survey.

The purpose of this cross-sectional study was to survey the backgrounds and perspectives of U.S. periodontal residents in 2012. A 64-item web-based survey was distributed to all periodontal residents in the United States (544 residents enrolled in 54 graduate programs) via email in March 2012. Data on the residents' demographics, experiences during graduate periodontal training, and goals were collected and analyzed, and percentages were calculated. The survey had a 19.1% response rate. Most of the respondents (74%) had graduated from international dental schools, and 81.7% were in combined programs (clinical training combined with a Master's degree, PhD, or other doctoral degree). Almost one-fourth of the responding residents (24%) reported a total debt of more than $300,000 after graduation. More than 60% of the respondents planned to practice in a private setting as an associate, partner, or solo practice owner. The responding residents reported having chosen their graduate programs based mainly on the programs' clinical education and reputation (72% and 48%, respectively). Future studies will determine educational trends and outcomes for periodontal residents in the longer term.

Survey of Australian and New Zealand Oral and Maxillofacial Surgery trainees and recent specialists--education and experience.

This study examined the demographic characteristics, educational background and attitudes toward training of all recent OMS specialists and all current trainees in Australia and New Zealand in 1996. The early nineties is a key period as it marks the transition from an essentially dentally based speciality (85% dental degree in 1990); to recent specialists with an increasing number with both medical and dental degrees (33% dual degree 1990-1996); to predominantly dual degree training (84.4% dual in 1996). Current trainees had more extensive experience in pathology, preprosthetic and reconstructive surgery. They were also strongly critical of the length and cost of training.

Dental public health for the 21st century: implications for specialty education and practice.

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6-8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.