21st Century DMD
Educating the next generation of dentists
Today’s dental students need to be nimble, and not just with their hands. Sure, they have four years to develop clinical expertise, but, it’s likely that they will be tested during their careers by changes in technology, practice models, government regulation and patient demographics.
That means dental students must now be taught with an eye on both the fundamentals of today and the possibilities for tomorrow. “If they’re learning techniques right now that in 30 years will be obsolete, how do we prepare students for that eventuality?” says
Nadeem Karimbux, associate dean of academic affairs at Tufts School of Dental Medicine. “What are some of the characteristics and skills students will need in order to deal with change and an uncertain future?”
The current curriculum stresses problem-solving, critical thinking and collaboration—qualities that Karimbux says will support lifelong learning and allow dentists to thrive in the evolving health-care landscape. Dental students were among the first at the university to use software to improve interaction in the classroom, he points out. In the clinic they are learning to use new technology and to employ evidence-based dentistry in making treatment decisions.
And in keeping with new national accreditation requirements, Tufts students are also being taught to communicate with their patients in culturally appropriate and easy-to-understand ways—for instance, drop the jargon and use “cavities” not “caries.” They are also encouraged to share their talent with the world beyond One Kneeland. “I find the student body has become more genuinely interested in community service,” says Executive Associate Dean Mark Gonthier.
Gontheir says that what motivates Tufts students to pursue dentistry has remained consistent: the desire to provide care for patients, and, for many, the ability to work more autonomously than in other branches of medicine. What’s changed, though, are the demographics: more women and underrepresented minorities; more students from outside New England; more students who publicly identify as gay or lesbian.
“Our students come here for the traditional dental career, but I think Tufts School of Dental Medicine changes people in ways they don’t fully anticipate,” Gonthier says. “They become more open-minded; they develop a more fundamental respect for diversity in all of its dimensions and they develop a better understanding of the complexities of the world.”
A Climate of Diversity
When it comes to creating a racially and ethnically diverse class, “our greatest recruiters are our students,” says Robert Kasberg, associate dean of admissions and student affairs. “I’ve seen our students do yeoman’s work convincing Latino and African-American applicants that the climate here is one that is friendly and welcoming and supportive.”
Women may remain a tick behind men in national dental school enrollment numbers, but they account for 57 percent of Tufts’ D18 and D19 classes. “More women are going to college, and on the average, are better students,” says Kasberg. Accordingly, first-year women have outnumbered men at Tufts dental school most years since 2008.
Teaching the Millennials
The average age of a first-year Tufts Dental student is 24. reaching this generation, which, studies show, values collaboration and flexibility, has transformed dental education. “The sense of competition that may have manifested itself in the past, has moved much more toward learning in groups,” says Richard Valachovic, president of the American Dental Education Association. Also different: they have information at their fingertips. “We need to teach them how to take that information and use it in a meaningful way,” says Karimbux. These ideas are reflected in a more integrated basic science curriculum, part of the school’s 2020 Vision strategic plan.
Setting a New Course
The Basic Science/Clinical Science Spiral Seminar Series (BaSiCSsss), which started in 2014, brings together teams of students from all four years to study and design treatment for clinical cases. The teams then present their findings to faculty and fellow students. Using case studies forces students to draw on knowledge across subjects, and first- and second-year students get early exposure to the clinical experience.
Less Stress is Best
A little mindfulness in between anesthesiology and epidemiology? Yes, please. Mid-day meditation is one component of Tufts’ increasing emphasis on student wellness. First-years are now introduced to stress reduction strategies during orientation, and a faculty member oversees mind-body wellness efforts for all students, faculty and staff. “The idea that we have to make you tough to survive in this profession no longer exists,” says Kasberg. “We want people to find healthy ways to handle the rigors of dental school, and to develop healthy habits that can carry into their professional and personal lives.”
All Together Now
Dentists love to point out that the mouth is attached to the rest of the body, a truth that is finally beginning to show up in new health-care delivery models that emphasize integration of specialties. Dentists are being taught to function as part of a team that cares for the entire body. Dental students now do externships at community health centers, work alongside hygiene and nutrition students in the Tufts clinics, volunteer with their health-sciences peers at outreach sites like the Sharewood Clinic and help treat psychiatric patients at Tufts Medical Center. “The isolation of the dental school from the rest of the academic health center is going away,” says ADEA’s Valachovic.
Instant Feedback in the Classroom
Using interactive classroom technology, faculty can display images or radiographs and students can ask or answer questions on their devices. “Faculty immediately know if the class is following along,” says Jennipher Murphy, educational technology senior administrator. The software can instantly assign a large class to teams, allowing for collaborative work. The dental and medical schools were the first health sciences schools at Tufts to use ExamSoft, a computer-based testing system that allows for a greater variety of questions than standard multiple-choice tests, along with instant grading. The point, Murphy says, is to find the technology that will best enable learning. “Sometimes technology is not the answer. You have to choose the appropriate tool to get the outcome you’re looking for.”
Hanging Out the Welcome Sign
Tufts was one of the first dental schools to sponsor a lesbian, gay, bisexual and transgender student group. And to this day, it remains one of just a handful of the nation’s 65 dental schools with one. A 2004 study in the Journal of Dental Education found two schools reporting LGBT groups; when Tufts researchers took another look in 2015, that number stood at 10.
“We’re definitely headed in the right direction, but we still have a long way to go,” says Associate Professor Amit Sachdeo, an adviser to the Lesbian, Gay, Bisexual, Transgender and Allies group. At a time when it’s still not uncommon for professional-school applicants to scrub their public personas of indications that they are gay, having an affinity group signals an accepting environment, Sachdeo says.
“If the dental school and university administration were not supportive, our group would not exist,” he says. “I think that’s an important message to get out to other institutions.”
Clinical Technology on the Cusp
Keeping pace with technology can be challenging for a private practice—so a newly hired associate may find herself greeted by either digital intraoral scanners with the latest software, or tried-and-true trays and elastomeric impression materials. That means clinical education now has to straddle the line between proficiency in traditional methods and preparedness for the future, says Ali Muftu, a professor of prosthodontics.
A prime example is the use of CAD/CAM—computer-aided design and manufacturing—to produce restorations. While CAD/CAM dentistry has been around since the late 1990s, Muftu says that with the development of new materials and better scanners, software and manufacturing systems, it has become easier and more common for dentists to take digital
impressions and make restorations chairside. The technology was introduced in the predoctoral clinics about five years ago, but many established practices have not made the investment that CAD/CAM requires. Partially for that reason, Muftu says, graduation requirements stipulate that the bulk of a student’s restorations must be done the “old-fashioned” way. “We have the old curriculum to teach, and the new approach to teach, and that is a challenge,” he says. However, “the fundamentals are still the same.”
Money Isn’t Everything
What steers the direction of a new dentist’s career? Paying off the cost of their education is one consideration, but it appears that other factors weigh even more heavily. A 2015 study in the Journal of the American Dental Association found that while graduates with higher levels of debt are more likely to enter private practice, loan repayment is not the driving force behind career choices.
“Gender and race were huge compared to debt,” says Marko Vujicic, vice president of the Health Policy Institute of the American Dental Association.
According to the JADA study, white, male graduates are statistically more likely than their female and non-white classmates to go into private practice and to own a practice eventually. So, too, are those graduates whose parents were also dentists. Women, meanwhile, are more likely to pursue teaching, research and public health. African-American graduates are more likely to go into public health, public service or specialty training, while Asians are more likely than other racial groups to join a dental school faculty.
Not Your Father’s Dental Practice
Tufts’ D16s will encounter a professional landscape unlike the one that greeted graduates even 10 years ago. The majority will still pursue private practice, but for many it will be in the form of a large group or corporate-managed practice. If trends continue, they will treat fewer middle-age adults, and more seniors, youngsters and patients with special needs or complex medical conditions. And their focus will extend beyond the dental office. “We will need to appreciate more than ever before that the mouth is connected to the body, and that body is connected to a family and a community,” says Valachovic.
As the overall health-care system changes, it’s expected that dentists will become engaged in collaborative care. Students are being educated with this in mind, but the shift could alter the independence traditionally valued by the profession, says Gonthier, the school’s executive associate dean. “Is that going to create a change in the kind of person attracted to pursuing dentistry?” he asks.
Helene Ragovin, the editor of this magazine, can be reached at firstname.lastname@example.org.