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.

A survey of ethical dilemmas and practical problems encountered by practicing dentists.

Dental practice has been subject to many changes in recent years, including third-party involvement, infection control requirements and a rise in litigation. The authors conducted a broad-based national survey of practitioners to learn their views on the ethical and practical problems facing today's dentist.

Patient satisfaction with dental care.

The feedback studies illustrate the fact that it is possible for the individual practitioner or member of a group practice to take positive steps to enhance satisfaction among his or her patients. Simply knowing about the general components of patient satisfaction is not enough; one needs to know about the views of one's own patients so that effective steps can be taken to improve them. The steps may include changes in office policies or procedures, facilities or staff changes, or even changes in the dentist's interpersonal approach. In any case, the evidence suggests that efforts to improve will be rewarded by more satisfied patients who will be more likely to stay as clients and, perhaps, more readily accept treatment and more frequently refer friends to the practice. The consistent role of dentists' interpersonal skills suggests that dental schools could contribute to patient satisfaction by providing more interpersonal skills development in their curricula. This was a major recommendation of the 1984 Future of Dentistry Final Report. The evidence presented in this chapter firmly supports that recommendation.

Opinions of pediatric dentists regarding their board certification process.

Despite frequently heard criticisms of the board certification process in pediatric dentistry, pediatric dentists have never been surveyed on this issue. To achieve a representative opinion, a formal survey was conducted during the summer and fall of 1990. The survey sample consisted of 300 practitioners selected randomly from the list of 4300 United States pediatric dentists. The survey form included demographic data, board status, general opinions about the process, and specific estimates of the reliability, validity, and utility of each of the five examination components. Comments were encouraged. A follow-up reminder was sent several weeks after the initial mailing. Ten forms were returned as undeliverable, reducing the sample to 290. In all, 150 forms were returned, for a return rate of 52%. One hundred and thirty-eight forms were completed and analyzed. This number included 54 pediatric Diplomates and 84 nonboarded pediatric dentists. The Written and Oral sections generally were rated more favorably than the Case History, Site Visit, and Simulation sections. Nonboarded respondents were significantly more critical of the process on every item, without exception. All differences exceeded the 0.01 level.

Results of a workshop on the development of TEAM training programs.

A two-week workshop was conducted to instruct current and potential directors of TEAM programs in planning and implementation of effective programs. A participant was sent by 36 of the 59 invited dental schools. Nineteen persons were selected as workshop faculty. The first week was spent in didactic sessions on educational methods, TEAM curriculum topics, and noncurricular issues. The second week was spent on development and review of original TEAM proposals. Significant overall gains in proficiency test scores were earned by both participants who came from schools with funded TEAM programs (n=16) and those from schools without funded programs (n=18). No test score differences were observed between these groups. The two areas of greatest perceived weakness at the end were evaluation and management training. Data on TEAM grant submissions during the two years following the workshop are discussed, along with several implications for planning of long-term workshops.

A correlational study of preadmission predictor variables and dental school performance.

The purpose of this study was to determine the predictive validity of preadmission scores on the performance of 131 students from nine successive classes at the Harvard School of Dental Medicine. The predictors included high school rank, SAT Verbal and Quantitative, selectivity of undergraduate college, college GPA, and DAT Academic, and PAT averages. The performance scores included science GPA, clinical GPA, oral examination scores, and scores on Parts I and II of the dental National Board examinations. Correlation coefficients were calculated between each predictor and performance measure. Only one was significantly greater than zero: DAT Academic average was positively related to Part II Board scores (r = .29). The apparent lack of validity of the other predictors was attributed to their restricted range.

A compendium of objectives for geriatric dentistry.

A two-phase survey was conducted with 82 persons identified as having special knowledge in geriatric dentistry. In Phase 1, they were asked to list competencies required of the geriatric dentist. In Phase 2, they were asked to rate the relative importance of 150 competencies for five different educational settings: dental school, general practice residency, prosthodontic specialty program, geriatric fellowship program, and continuing education. The resulting compendium of objectives suggests that geriatric dentistry should become integrated into general dentistry, with relatively few competencies reserved for specialists.

Factors that influence minority dental students' career plans.

Questionnaires were mailed to all 443 minority senior dental students and to a randomly selected control group of 200 nonminority seniors. Questions were asked about background income, debt, and future plans. Minorities reported lower family income, but similar debt levels. Minorities were more likely to locate in a minority community, less likely to enter solo practice. About one-third of each group stated that debt influenced practice plans. However, only the minority plans appeared to vary with debt: as debt increased, minorities were less likely to plan a solo private practice.

Treatment planning in dental schools.

Treatment planning is a complex process that is difficult to teach and evaluate. Various frameworks have been used to organize the decision-making process. While many have merit, the transition from ideal to realistic plan is rarely described in detail adequate for teaching purposes. None of the research recommends an objective method to measure students' treatment planning skills. A treatment planning model is described that would follow presentation of the "ideal" treatment plan in the curriculum. The model focuses specifically on the sequence of decisions necessary to formulate appropriate treatment plans for adult dental patients who present with compromising factors. Also, a method is suggested for objective evaluation of dental students' mastery of dental treatment planning at each of several intermediate steps, as well as at the final result.

Effects of a curriculum change on dental student attitudes.

This study compared student attitudes before and after the change from a four- to a five-year D.M.D. program at the Harvard School of Dental Medicine. Three instruments were used to collect data from eight successive classes, the last four enrolled in the original program (classes of 1979-1982) and the first four enrolled in the new program (classes of 1984-1987). Overall participation rate was 89 percent. The scales were: (1) the Survey of Interpersonal Values (SIV); (2) a bipolar adjective checklist, The Job of Dentistry, which reveals views of the profession, and (3) Career Plans. The same set of scales was administered for a second time, upon graduation, to the classes of 1980-1982. Only two changes were noted between first and second administrations for these three classes: at graduation, the job of dentistry was viewed as more sales-oriented and more physical. Comparing the two programs, students in the new (five-year) program scored significantly higher on leadership in the Survey of Interpersonal Values. Five-year students viewed the job of dentistry as significantly more changing, complicated, unusual, intellectual, scientific, interesting, and involving more public speaking, and their career plans tended to be more academically oriented.

A study of the impact of Project ACORDE on dental education in the United States.

As part of an evaluation of Project ACCORDE a questionnaire survey was conducted of all U.S. dental school deans, heads, and selected faculty of operative dentistry departments, and selected directors and key faculty of dental hygiene and assisting programs. The survey was supplemented by on-site visits to four dental school operative dentistry departments and five dental auxiliary training programs where the Restoration of Cavity Preparations with Amalgam and Tooth-Colored Materials package was used. The visits included observation of instruction and interviews with faculty and students. This paper summarizes the results including: the extent to which the materials have been adopted, user and nonuser reactions, perceived costs and benefits, and implications for the future of Project ACORDE.

A taxonomy for behavioral objectives in a dental school.

This paper describes a taxonomy proposed for use by dental school faculties as an aid in specifying their course objectives in behavioral terms. This taxonomy, developed and tried at the Harvard School of Dental Medicine, is simpler than taxonomies previously proposed because it reduces the number of categories. In addition, the categories themselves are designed to communicate to and be interpreted by dental educators. The six categories are (1) knowledge of facts, concepts, and principles; (2) comprehension; (3) perceptual ability; (4) diagnosis and treatment planning skills; (5) motor skills; and (6) interactive skills. Each category is briefly defined and illustrated with two samples from operative dentistry.

Correlates of dentists' attitudes toward continuing education in TEAM.

All dentists in active practice in Rhode Island were surveyed to determine their attitudes toward continuing education in TEAM. A total of 74.6 percent of those surveyed responded to the questionnaire. Only one variable, location in a building with other dental offices, was found to be associated with a perceived need for training in TEAM. Demographic background, practice busyness, practice efficiency, and knowledge and attitude profiles were found to be associated with an interest in attending such continuing education courses.