Spring 2019

The Case for Teaching

For those who fall under the spell, there’s joy in guiding new dentists in the classroom and clinic.

By Helene Ragovin

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Illustration: Joel Kimmel

Fields Farrior, D08, started his career in private practice just after graduation, and he enjoyed it. But a few years in, he increasingly found himself looking forward to Wednesdays, the day when he would travel from Exeter, New Hampshire, to Boston, where he volunteered to teach in the clinics at Tufts School of Dental Medicine. “I caught the bug,” Farrior said. In 2013, he left private practice to work full time at the University of New England’s College of Dental Medicine in Maine, where he is now associate dean of clinical education and patient care. He hasn’t regretted the decision.

“Coaching students through their anxiety around doing a procedure for the first time, helping them realize they are prepared to perform the procedure, is great,” Farrior said. “It is so rewarding when you see the patients smiling, appreciative, and healthier, due to the care students provide.”

These kinds of multiplied joys—the ability to make a difference for students and for patients—are major recommendations for an academic lifestyle. And so are the other perks that come with a faculty position, such as health and life insurance, retirement savings plans, disability coverage, paid vacation, and sick time. As running an independent practice as a small business—traditionally one of the appeals of dentistry—becomes more expensive and time-consuming, the choice of academia becomes increasingly appealing, especially for a millennial generation that puts a premium on work-life balance.

“There are benefits to an academic environment that we don’t do a very good job of sharing with students,” said Tufts School of Dental Medicine Dean Huw Thomas.

Now more than ever, communicating the advantages of a teaching career—as well as stepping up training for new educators, fostering faculty diversity, and making teaching financially feasible for young dentists—is critical. That’s because a significant number of instructors across the country are now in their fifties, sixties, and older, either nearing retirement age or moving beyond it. And with not enough younger teachers to meet the looming demand, it raises the question: Who will teach the next generation of dentists?

According to the American Dental Education Association (ADEA), the largest cohort of full- and part-time faculty at US dental schools is between the ages of sixty and sixty-nine—in other words, the demographically dominant Baby Boomers. At Tufts, the mean age of the 212 benefits-eligible faculty members is fifty-three. Sixty-seven of the faculty members are between sixty and seventy-nine, and six are over the age of eighty.

Sources: American Dental Education Association, survey of dental school faculty; Tufts School of Dental Medicine, as of January 3, 2019. *Includes tenure/tenure-track and
full-time/part-time benefits-eligible faculty.

At schools across the country, a significant portion of older instructors postponed retirement during the Great Recession. Many are now expected to retire soon. “When we look at the number of retirements, we do need to be worried about the future,” said ADEA president and CEO Richard Valachovic. A 2011 paper in the Journal of Dental Education (JDE)—coauthored by Tufts oral surgery chair Maria Papageorge, D82, DG86, DG89—put it even more starkly: “Clinical faculty shortages could be characterized as the most critical challenge confronting dentistry.”

Among the recommendations from the JDE study was mandatory mentoring for junior faculty. Research shows mentoring relationships increase a new teacher’s sense of confidence; they also provide a mechanism for junior faculty to receive guidance in research, teaching skills, and professional development. At Tufts, Carroll Ann Trotman, professor and chair of orthodontics, is also the school’s first associate dean for faculty development. In this new role, she meets with department heads to coordinate mentoring and training.

Of course, a great deal of mentoring is more informal. When Irina Dragan, DG15, transitioned from a periodontology resident to an assistant professor, the same senior faculty members who mentored her as a student helped her learn academic tasks such as developing a syllabus and grading. Between training in surgery as a student and learning the science of teaching and learning as a beginning professor there’s “a huge gap,” Dragan said, “I’ve been fortunate to have great mentors, and they were there for me, so I didn’t feel lost.”

The JDE paper also suggested salary adjustments to address the wage disparity between academia and private practice. Nationwide, DMD graduates leave school with an average of $285,000 in debt, according to 2018 ADEA figures, and the paper found general dentists who teach can expect to earn $86,000 a year less than their counterparts in practice. Most universities aren’t likely to have the budget to offer earning parity with the private sector, but they might provide other incentives, such as loan-repayment or loan-forgiveness programs. Farrior, for example, took advantage of the Tufts Loan Repayment Assistance Program (LRAP), for graduates across all of the university’s schools who go into service, nonprofit, or academic careers.

The idea behind LRAP—to encourage graduates to follow the call of public service—goes hand-in-hand with the ethos of the health-science professions. “Consider that as a health-care provider, you have a responsibility to society to give back,” Dragan tells her students. “Early in your career, when you have a lot of debt, you’re not able to donate a lot of money, so that’s the time for community service and teaching,” even on a part-time basis.

Addressing the teaching crisis will take time, but established professionals can help bridge the gap, particularly in clinical instruction. In 2017, a little more than one-third of new faculty at US dental schools came to academia from private practice, according to ADEA. Those mid- or late-career professionals often come looking for new challenges or a second act after private practice or military service.

When the University of New England opened its dental school in 2013, it had only five years to fill roughly forty full-time positions. Teaching hand skills, for example, involves one-on-one instruction, so there was also a pressing need for part-time clinical faculty. The founding deans convinced local Maine practitioners to come in one or two days a week to help. Before the first year was out, Farrior said, a few of the recruits “had caught the fever, sold their practices, and come on full time.”

Relying on experienced clinicians isn’t new for Tufts, which has a long tradition of volunteer faculty—mostly alumni—who donate their time to the dental school and its students. “These clinicians are vital for the skill and expertise they bring to our teaching program,” Thomas said.

But even expert dentists need some guidance to become confident teachers in the twenty-first century. Immediate access to information has eliminated the need for most memorization; students now prefer to work in groups and use case- and problem-based methods of learning. The very atmosphere in dental education has shifted. “Today,” said Carole Palmer, longtime professor of comprehensive care, “things are much less brutal, more student-centered, more patient-centered.”

Sources: American Dental Education Association, survey of dental school faculty; Tufts School of Dental Medicine, as of January 3, 2019. *Includes tenure/tenure-track and
full-time/part-time benefits-eligible faculty.

To support its teachers, Tufts dental school has sent people to ADEA’s Emerging Academic Leaders program for junior faculty, ADEA’s yearlong Leadership Institute, and the ADEA/AAL Institute for Teaching and Learning. Others have attended the Executive Leadership in Academic Medicine program for women, offered through Drexel University. Tufts also participates in the ADEA Academic Careers Fellowship Program, which offers opportunities for mentoring, supervised teaching experience, and more, as a way to encourage DMD students and residents to enter the academic pipeline. Early-career educators can enroll in the dental school’s one-year professional certification program known as the Dental Education Learning and Teaching Academy (DELTA) fellowship.

In addition, the school has also developed programs and revised policies to train and retain teachers. The Teaching and Learning in an Environment of New Technology (TALENT) committee, for example, supports education-related research, pinpoints research areas that need attention, and more.

The school has also revamped its promotion policies, to provide advancement opportunities, and guidance, to all faculty, regardless of full-time, part-time, or volunteer status. Gone are the days when tenure hinged on doing bench science. Now, Tufts faculty can choose to focus on pedagogy and educational research. Those are steps that go a long way, Palmer said, toward keeping faculty on board.

If dental schools manage to persuade more young graduates and mid-career pros to come on board, they will have the teachers they need to train the next generation. But along the way, schools will also get something more: faculties that mirror more closely the diversity of the student bodies they teach, with more women, more people of color, more socioeconomic diversity. “We know that in order for students to succeed, they need role models and mentors with whom they can identify,” said Rosa Chaviano-Moran, assistant dean of admissions and recruitment at Rutgers University School of Dental Medicine.

She and her colleague Herminio Perez spent a recent morning at Tufts for an ADEAGies Foundation seminar to acquaint students with academic dentistry. Students from underrepresented backgrounds have historically been less likely to consider teaching careers, Chaviano-Moran told the students gathered in Merritt Auditorium, but the opportunities are there: “There are going to be slots for people like those in this audience,” she said.

And, undoubtedly, future faculties will be heavily female. This is a change that is already well underway at Tufts. According to ADEA statistics, 69 percent of dental faculty who retired during the 2015-16 academic year were men. At Tufts, faculty over age fifty are predominantly male, but the group under age fifty are evenly split between men and women. For those under age forty, two-thirds of instructors at the School of Dental Medicine are women—as are five out of nine department chairs.

“There is a group of young women who are eager, capable, and want to teach,” Thomas said. “How do we create an environment within the school that fosters not just women, but all young faculty who want to move forward?”

The answer to that question, and to the broader one of attracting the next generation of teachers, starts with sharing the rewards of an academic path. Some of those rewards are tangible. But some of them are less so, though just as powerful. “A teaching career always keeps you learning what’s new,” Dragan said. “In teaching, the more you give, the more you get back.”

Contact Helene Ragovin, the editor of this magazine, at helene.ragovin@tufts.edu.

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