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Guidelines for Dental Education Programs
REPORTS OF COUNCILS AND BUREAUS
Guidelines for dental education programs
Council on Dental Education A t its May 1971 meeting, the Council on Dental Education reviewed the “Guidelines for Dental Education Programs” developed at the request o f the 1970 A D A House o f Delegates to augment the approved revision in “Requirements for an Accredited School o f Dentistry.” The “G uide lines” are intended to provide dental schools with Council interpretations o f specific sections o f the “Requirements.” The Council endorsed the “Guide lines” in principle, for inclusion in the publication Procedures fo r Evaluation, Requirem ents and Guidelines fo r Dental Education Programs. Included in the publication are “Guidelines for Predoctoral Education in Hospital Dentistry,” prepared jointly by a special committee o f the Councils on Dental Education and Hospital D en tal Service in response to the recommendation o f the Council on Hospital Dental Service approved by the 1970 A D A House o f Delegates. The Coun cil endorsed the “Guidelines” in principle, as amended, for inclusion in the publication. The “G uidelines for Dental Education Pro grams” included in the Council publication are as follows: The “Requirements for an Accredited School o f Dentistry,” approved by the American Dental Association in November 1970, represents an ex tensive modification in Council requirements for dental education programs. Educational requirements used for accredita tion purposes are generally cast in broad terms to allow flexibility and interpretation. Specifically, the “Requirements” for dental education pro grams were developed to encourage educational
institutions to be responsive to the need for cur ricular change and experimentation. Further, the “Guidelines” are not intended to impose restric tions not included in the “Requirements.” During the extensive consideration o f the new standards for dental education programs, it was evident that there was some misinterpretation o f the intent and meaning o f the new educational re quirements. Therefore, it was recommended that guidelines be developed by the Council on Dental Education, interpreting the “Requirements.” The following guidelines represent advisory opinions o f the Council on Dental Education. ■ University relationship: The “Requirements” stipulate that any school o f dentistry which seeks accreditation must be a “component o f a recog nized institution or system o f higher education.” The Council prefers the formal university relation ship; however, it accepts the development o f den tal education programs which are under the aus pices o f a state system o f higher education, but not formally part o f any university. The term “system o f higher education” refers to state recognition or chartered by the state. For example, a dental school developed in a state recognized health edu cation center (nonuniversity related) would be acceptable. Essentially, this requirement relates to the need for quality education as exem plified by a univer sity system o f education. The Council encourages formal university relationships since there are many benefits which accrue to both the dental education program and the university. JADA, Vol. 83, September 1971 ■ 647
■ Financial management and support: The Coun cil requires evidence that sufficient financial sup port is available to the dental education program to permit quality instruction. The Council expects to have available for its review, on an annual basis, adequate financial information which will determine accurately the financial costs related to the dental education program. The financial in formation must be comprehensive and include data pertaining not only to the dental school but also to other related health educational programs. The Council expects that accurate financial in formation be maintained by the institution and made available to the Council on Dental Educa tion on a confidential basis. ■ Physical facilities: The Council does not stipu late or encourage a specific type o f physical fa cility arrangement and recognizes that variations in curriculum often dictate dissimilar facility con figurations. The physical facilities and related structures should augment the dental curriculum and provide for a motivating learning environ ment. The facilities should include the most modern equipment available to teach current curricular concepts. For example, clinical facilities should permit the effective utilization o f dental auxiliaries. ■ Library: In the light o f the continuing advance ments in the science o f dentistry, the Council rec ommends that adequate learning center facilities and related services be available for student and faculty use. Libraries should be learning centers and should provide substantial collections o f ref erence books, periodicals, audiovisual materials, and information retrieval systems. The Council encourages expanded development and use o f modern techniques o f information retrieval and encourages the library to become an active force in promoting student, faculty, and staff under standing o f the information available for their use. Demonstration o f an effective interlibrary loan system is considered an essential aspect o f a quality library service. ■ Adm issions: The “Requirements” clearly note a significant revision in policy and interpretation pertaining to the admission o f qualified students for dental education programs. Formerly, the ad m issions section included specific required preden tal courses. A lso, two years o f preprofessional education Was established as the minimum require ment for admission to dental school.
Although the new standards no longer stipulate course and length requirements, the Council on Dental Education supports the current dental school position o f seeking students with baccalau reate degrees. The Council’s rationale in remov ing the specificity in admission requirements was based on the premise that greater flexibility should be allowed admissions committees in order to rec ognize and promote alternate procedures for ac cepting candidates. For example, advanced place ment credit procedures and the possibility o f ex perimenting with an integrated preprofessional and professional program are two concepts which do not dilute the admission standards but were prohibited by the previous “Requirements.” By eliminating the previous restriction, dental schools will be in a position to devise specialized student programs and develop different curricular ap proaches for the preprofessional and professional course o f study. The Council is relying on the judgment o f the individual dental school admissions committees to establish specific admission requirements and to select appropriate candidates. The “Requirements” seek to encourage the selection o f educationally diverse and qualified students for dental education programs. The Council is o f the opinion that the current admis sions section may not be sufficiently explicit for preprofessional advisers. Therefore, the Council believes it is incumbent on the dental educational institutions to inform the advisers and applicants concerning specific predental educational require ments. The Council will continue a study o f the char acteristics o f incoming students to ensure that qual ity o f accepted students is being maintained. Fur ther, the Council will require annual reports from each dental school concerning student perfor mance. The Council encourages dental schools to use studies prepared by the Division o f Educational Measurements related to the Dental Admission Testing Program. Schools are encouraged to eval uate admission data and other characteristics re lated to the dental student population, in order to improve the selection o f students. ■ Curriculum: The Council on Dental Education is o f the opinion that dental education must be responsive to the changes occurring in higher edu cation and provide an educational setting for stu dents and faculty which promotes the develop ment o f more effective learning experiences. Fur
648 ■ REPORTS OF COUNCILS AND BUREAUS / JADA, Vol. 83, September 1971
ther, the Council on Dental Education recognizes that there are individual student differences. There fore, the Council encourages a curricular approach that allows for individual student differences and permits the development o f more flexible teaching programs. This mechanism allows students to pro ceed at a pace consistent with their learning ability. It appears that such programs would diminish the current attrition rate and allow exceptional stu dents to com plete the educational period earlier. It also allows for early specialization or the pur suit o f additional education in a different field. The Council believes that educational flexibility will contribute to greater student motivation and better learning as well as perhaps the develop ment o f a faculty challenged by the requirement to improve continually their respective teaching disciplines. The section o f the “Requirements” concerning the length o f the educational program does not suggest, nor does the Council intend, that there should be a uniform time decrease in the dental curriculum. The Council does not believe that there is sufficient evidence, at this time, to estab lish a uniform three academic year dental educa tional program. There iscom m on misunderstanding between the aspect o f a “shortened” curriculum and a “compressed” dental education curriculum. In this regard, the Council has not established a policy but rather has suggested that dental educa tional institutions experiment with different forms o f educational curriculums in order to determine the methods best suited to future dental education programs. ■ Faculty: Traditionally, the Council on Dental Education has taken the position that it will not establish, or suggest, specific student-teacher ra tios. The Council is steadfast in this opinion and concurs with the inappropriateness o f establishing, on a national basis, teaching requirements which, in essence, must be related to the curriculum, phys ical facilities, and teaching procedures o f the indi vidual school. The Council on Dental Education views faculty as the most critical element comprising an effective dental education program and encourages the den tal schools to develop in-service faculty improve ment programs to ensure the continuous com pe tency o f the faculty. Dental schools that increase student enrollment will be expected to supplement faculty in order to prevent a dilution o f the edu cational quality. Further, dental administrators are encouraged to seek faculty members who have
appropriate advanced education and who intend to devote their professional career to education. ■ H ospital and m edical school relationships: Cur rent trends in health care delivery indicate that the nature o f dental practice is undergoing drastic change and is likely to change even more so in the years to come. Emphasis in dental and m edi cal education is on comprehensive patient care with a team approach to the delivery o f treatment. Because o f changes in life expectancy, advances in medical and dental care, third party payment programs, and changes in emphasis in dental edu cation, more patients in the future will receive dental treatment as a com ponent o f com prehen sive health care in the hospital environment and other similar institutions. The resources o f the dental school serve an es sential role in rendering patient care within the hospital. The presence o f the dental students and their supporting staff in the hospital contributes to and complements the educational programs o f other students on the health team. Acknowledging that dentists as members o f the health team will need to work together with others within the hos pital for the delivery o f comprehensive health care, it is appropriate that their educational ex perience in this environment begin at the predoctoral level. The general thrust in dental education has de veloped the concept that students and faculty work together as professional colleagues in the develop ment o f a learning-teaching experience. The hos pital provides the environment to promote effec tive intraprofessional and interprofessional rela tionships. Traditional methods o f providing biomedical science instruction based on the exclusive depen dence on lecture and laboratory methods cannot provide adequate insight or relevancy in under standing systemic disease processes. Therefore, to supplement teaching in the biomedical sciences, time should be spent in the hospital examining patients and discussing systemic disease. In this way, students would more fully understand systemic and regional disease processes, and the general and dental implications o f disease. The primary role o f the hospital in predoctoral dental education should be to reinforce in the stu dent the concept o f the total patient and the appli cation o f the biomedical sciences. Specifically, a predoctoral dental education program should pre pare the student to perform, in the hospital, any and all o f those functions considered to be part o f
REPORTS OF COUNCILS AND BUREAUS / JADA, Vol. 83, September 1971 ■ 649
the general practice o f dentistry for those patients whose general health dictates that they must re ceive treatment in the hospital. Students shall be educated in hospital procedures so that ultimately they can serve as members o f medical staffs o f hospitals. The hospital educational system provides the environment in which the predoctoral student can gain knowledge in hospital protocol and prac tice. The student should obtain general informative experience in hospital organization, protocol, and administration. This program should include a description o f the role o f the hospital in the de livery o f comprehensive patient care and the role and scope o f dentistry as part o f that care rendered to those o f all socioeconomic groups. It should include the indications for treating patients in the hospital, in both its inpatient and outpatient fa cilities. Further, this opportunity enhances the student’s educational background by reinforcing the applied biomedical and clinical sciences. In addition to basic hospital procedure, the predoctoral dental student should be taught physical evaluation m eth ods which will permit him to recognize and under stand the pathologic physiology o f systemic dis ease and its influence on oral health and treatment. Experience in clinical laboratory science emphasiz ing the mechanisms related to ordering laboratory examinations and tests and being able to interpret and utilize laboratory data should also be in cluded. The areas o f applied pharmacology and pain control should be incorporated in the stu dent’s predoctoral experience and reinforced in the hospital education program. Further, students should have an opportunity to participate in the treatment o f patients with acute and chronic sys temic conditions, including special patients who are under the care o f the total health team. Emer gency care experience in the control o f dentally related emergencies should be available for the student and include hospital emergency room ex perience. The student should learn to function as
a member o f the disaster team. It is essential that the school o f dentistry have an affiliation with the university hospital or with one or more teaching hospitals. Hospitals utilized must have a dental service approved by the Coun cil on Hospital Dental Service o f the American Dental Association. Effective affiliation between the school and the hospital requires formal agree ments and an established policy base which gov erns all responsibility and authority. Joint ap pointments shall be made where appropriate at both institutions. Finally, essential resources for a hospital den tal program should include adequate staff, phys ical facilities, and fiscal support to fulfill the o b jectives o f the predoctoral hospital education program. ■ Summary: It should be pointed out that the Council on Dental Education will continue to review and evaluate dental schools for accredi tation. A s a part o f this responsibility, the Council will assist dental education programs in improv ing the quality o f education. In the final analysis, accreditation and its self-study procedures should provide stimulation to institutions to ensure co n tinued growth and improvement in the teaching program. Accreditation has matured from the orig inal methodology which based the institutional evaluation on specific minimum requirements such as endowment, size o f library, number o f academic departments, size o f classes, and num ber o f credit hours for graduation. Although such specificity may have been approrpriate for an earlier era, the development o f similar standards today would, in essence, evaluate and standardize education on a basis o f relatively unimportant factors. The Council on Dental Education con curs with this view and, therefore, has developed the “Requirements” to reflect education per missiveness within the confines o f responsible judgment.
650 ■ REPORTS OFCOUNCILS AND BUREAUS I JADA, Vol. 83, September 1971
Guidelines for dental education programs
Council on Dental Education A t its May 1971 meeting, the Council on Dental Education reviewed the “Guidelines for Dental Education Programs” developed at the request o f the 1970 A D A House o f Delegates to augment the approved revision in “Requirements for an Accredited School o f Dentistry.” The “G uide lines” are intended to provide dental schools with Council interpretations o f specific sections o f the “Requirements.” The Council endorsed the “Guide lines” in principle, for inclusion in the publication Procedures fo r Evaluation, Requirem ents and Guidelines fo r Dental Education Programs. Included in the publication are “Guidelines for Predoctoral Education in Hospital Dentistry,” prepared jointly by a special committee o f the Councils on Dental Education and Hospital D en tal Service in response to the recommendation o f the Council on Hospital Dental Service approved by the 1970 A D A House o f Delegates. The Coun cil endorsed the “Guidelines” in principle, as amended, for inclusion in the publication. The “G uidelines for Dental Education Pro grams” included in the Council publication are as follows: The “Requirements for an Accredited School o f Dentistry,” approved by the American Dental Association in November 1970, represents an ex tensive modification in Council requirements for dental education programs. Educational requirements used for accredita tion purposes are generally cast in broad terms to allow flexibility and interpretation. Specifically, the “Requirements” for dental education pro grams were developed to encourage educational
institutions to be responsive to the need for cur ricular change and experimentation. Further, the “Guidelines” are not intended to impose restric tions not included in the “Requirements.” During the extensive consideration o f the new standards for dental education programs, it was evident that there was some misinterpretation o f the intent and meaning o f the new educational re quirements. Therefore, it was recommended that guidelines be developed by the Council on Dental Education, interpreting the “Requirements.” The following guidelines represent advisory opinions o f the Council on Dental Education. ■ University relationship: The “Requirements” stipulate that any school o f dentistry which seeks accreditation must be a “component o f a recog nized institution or system o f higher education.” The Council prefers the formal university relation ship; however, it accepts the development o f den tal education programs which are under the aus pices o f a state system o f higher education, but not formally part o f any university. The term “system o f higher education” refers to state recognition or chartered by the state. For example, a dental school developed in a state recognized health edu cation center (nonuniversity related) would be acceptable. Essentially, this requirement relates to the need for quality education as exem plified by a univer sity system o f education. The Council encourages formal university relationships since there are many benefits which accrue to both the dental education program and the university. JADA, Vol. 83, September 1971 ■ 647
■ Financial management and support: The Coun cil requires evidence that sufficient financial sup port is available to the dental education program to permit quality instruction. The Council expects to have available for its review, on an annual basis, adequate financial information which will determine accurately the financial costs related to the dental education program. The financial in formation must be comprehensive and include data pertaining not only to the dental school but also to other related health educational programs. The Council expects that accurate financial in formation be maintained by the institution and made available to the Council on Dental Educa tion on a confidential basis. ■ Physical facilities: The Council does not stipu late or encourage a specific type o f physical fa cility arrangement and recognizes that variations in curriculum often dictate dissimilar facility con figurations. The physical facilities and related structures should augment the dental curriculum and provide for a motivating learning environ ment. The facilities should include the most modern equipment available to teach current curricular concepts. For example, clinical facilities should permit the effective utilization o f dental auxiliaries. ■ Library: In the light o f the continuing advance ments in the science o f dentistry, the Council rec ommends that adequate learning center facilities and related services be available for student and faculty use. Libraries should be learning centers and should provide substantial collections o f ref erence books, periodicals, audiovisual materials, and information retrieval systems. The Council encourages expanded development and use o f modern techniques o f information retrieval and encourages the library to become an active force in promoting student, faculty, and staff under standing o f the information available for their use. Demonstration o f an effective interlibrary loan system is considered an essential aspect o f a quality library service. ■ Adm issions: The “Requirements” clearly note a significant revision in policy and interpretation pertaining to the admission o f qualified students for dental education programs. Formerly, the ad m issions section included specific required preden tal courses. A lso, two years o f preprofessional education Was established as the minimum require ment for admission to dental school.
Although the new standards no longer stipulate course and length requirements, the Council on Dental Education supports the current dental school position o f seeking students with baccalau reate degrees. The Council’s rationale in remov ing the specificity in admission requirements was based on the premise that greater flexibility should be allowed admissions committees in order to rec ognize and promote alternate procedures for ac cepting candidates. For example, advanced place ment credit procedures and the possibility o f ex perimenting with an integrated preprofessional and professional program are two concepts which do not dilute the admission standards but were prohibited by the previous “Requirements.” By eliminating the previous restriction, dental schools will be in a position to devise specialized student programs and develop different curricular ap proaches for the preprofessional and professional course o f study. The Council is relying on the judgment o f the individual dental school admissions committees to establish specific admission requirements and to select appropriate candidates. The “Requirements” seek to encourage the selection o f educationally diverse and qualified students for dental education programs. The Council is o f the opinion that the current admis sions section may not be sufficiently explicit for preprofessional advisers. Therefore, the Council believes it is incumbent on the dental educational institutions to inform the advisers and applicants concerning specific predental educational require ments. The Council will continue a study o f the char acteristics o f incoming students to ensure that qual ity o f accepted students is being maintained. Fur ther, the Council will require annual reports from each dental school concerning student perfor mance. The Council encourages dental schools to use studies prepared by the Division o f Educational Measurements related to the Dental Admission Testing Program. Schools are encouraged to eval uate admission data and other characteristics re lated to the dental student population, in order to improve the selection o f students. ■ Curriculum: The Council on Dental Education is o f the opinion that dental education must be responsive to the changes occurring in higher edu cation and provide an educational setting for stu dents and faculty which promotes the develop ment o f more effective learning experiences. Fur
648 ■ REPORTS OF COUNCILS AND BUREAUS / JADA, Vol. 83, September 1971
ther, the Council on Dental Education recognizes that there are individual student differences. There fore, the Council encourages a curricular approach that allows for individual student differences and permits the development o f more flexible teaching programs. This mechanism allows students to pro ceed at a pace consistent with their learning ability. It appears that such programs would diminish the current attrition rate and allow exceptional stu dents to com plete the educational period earlier. It also allows for early specialization or the pur suit o f additional education in a different field. The Council believes that educational flexibility will contribute to greater student motivation and better learning as well as perhaps the develop ment o f a faculty challenged by the requirement to improve continually their respective teaching disciplines. The section o f the “Requirements” concerning the length o f the educational program does not suggest, nor does the Council intend, that there should be a uniform time decrease in the dental curriculum. The Council does not believe that there is sufficient evidence, at this time, to estab lish a uniform three academic year dental educa tional program. There iscom m on misunderstanding between the aspect o f a “shortened” curriculum and a “compressed” dental education curriculum. In this regard, the Council has not established a policy but rather has suggested that dental educa tional institutions experiment with different forms o f educational curriculums in order to determine the methods best suited to future dental education programs. ■ Faculty: Traditionally, the Council on Dental Education has taken the position that it will not establish, or suggest, specific student-teacher ra tios. The Council is steadfast in this opinion and concurs with the inappropriateness o f establishing, on a national basis, teaching requirements which, in essence, must be related to the curriculum, phys ical facilities, and teaching procedures o f the indi vidual school. The Council on Dental Education views faculty as the most critical element comprising an effective dental education program and encourages the den tal schools to develop in-service faculty improve ment programs to ensure the continuous com pe tency o f the faculty. Dental schools that increase student enrollment will be expected to supplement faculty in order to prevent a dilution o f the edu cational quality. Further, dental administrators are encouraged to seek faculty members who have
appropriate advanced education and who intend to devote their professional career to education. ■ H ospital and m edical school relationships: Cur rent trends in health care delivery indicate that the nature o f dental practice is undergoing drastic change and is likely to change even more so in the years to come. Emphasis in dental and m edi cal education is on comprehensive patient care with a team approach to the delivery o f treatment. Because o f changes in life expectancy, advances in medical and dental care, third party payment programs, and changes in emphasis in dental edu cation, more patients in the future will receive dental treatment as a com ponent o f com prehen sive health care in the hospital environment and other similar institutions. The resources o f the dental school serve an es sential role in rendering patient care within the hospital. The presence o f the dental students and their supporting staff in the hospital contributes to and complements the educational programs o f other students on the health team. Acknowledging that dentists as members o f the health team will need to work together with others within the hos pital for the delivery o f comprehensive health care, it is appropriate that their educational ex perience in this environment begin at the predoctoral level. The general thrust in dental education has de veloped the concept that students and faculty work together as professional colleagues in the develop ment o f a learning-teaching experience. The hos pital provides the environment to promote effec tive intraprofessional and interprofessional rela tionships. Traditional methods o f providing biomedical science instruction based on the exclusive depen dence on lecture and laboratory methods cannot provide adequate insight or relevancy in under standing systemic disease processes. Therefore, to supplement teaching in the biomedical sciences, time should be spent in the hospital examining patients and discussing systemic disease. In this way, students would more fully understand systemic and regional disease processes, and the general and dental implications o f disease. The primary role o f the hospital in predoctoral dental education should be to reinforce in the stu dent the concept o f the total patient and the appli cation o f the biomedical sciences. Specifically, a predoctoral dental education program should pre pare the student to perform, in the hospital, any and all o f those functions considered to be part o f
REPORTS OF COUNCILS AND BUREAUS / JADA, Vol. 83, September 1971 ■ 649
the general practice o f dentistry for those patients whose general health dictates that they must re ceive treatment in the hospital. Students shall be educated in hospital procedures so that ultimately they can serve as members o f medical staffs o f hospitals. The hospital educational system provides the environment in which the predoctoral student can gain knowledge in hospital protocol and prac tice. The student should obtain general informative experience in hospital organization, protocol, and administration. This program should include a description o f the role o f the hospital in the de livery o f comprehensive patient care and the role and scope o f dentistry as part o f that care rendered to those o f all socioeconomic groups. It should include the indications for treating patients in the hospital, in both its inpatient and outpatient fa cilities. Further, this opportunity enhances the student’s educational background by reinforcing the applied biomedical and clinical sciences. In addition to basic hospital procedure, the predoctoral dental student should be taught physical evaluation m eth ods which will permit him to recognize and under stand the pathologic physiology o f systemic dis ease and its influence on oral health and treatment. Experience in clinical laboratory science emphasiz ing the mechanisms related to ordering laboratory examinations and tests and being able to interpret and utilize laboratory data should also be in cluded. The areas o f applied pharmacology and pain control should be incorporated in the stu dent’s predoctoral experience and reinforced in the hospital education program. Further, students should have an opportunity to participate in the treatment o f patients with acute and chronic sys temic conditions, including special patients who are under the care o f the total health team. Emer gency care experience in the control o f dentally related emergencies should be available for the student and include hospital emergency room ex perience. The student should learn to function as
a member o f the disaster team. It is essential that the school o f dentistry have an affiliation with the university hospital or with one or more teaching hospitals. Hospitals utilized must have a dental service approved by the Coun cil on Hospital Dental Service o f the American Dental Association. Effective affiliation between the school and the hospital requires formal agree ments and an established policy base which gov erns all responsibility and authority. Joint ap pointments shall be made where appropriate at both institutions. Finally, essential resources for a hospital den tal program should include adequate staff, phys ical facilities, and fiscal support to fulfill the o b jectives o f the predoctoral hospital education program. ■ Summary: It should be pointed out that the Council on Dental Education will continue to review and evaluate dental schools for accredi tation. A s a part o f this responsibility, the Council will assist dental education programs in improv ing the quality o f education. In the final analysis, accreditation and its self-study procedures should provide stimulation to institutions to ensure co n tinued growth and improvement in the teaching program. Accreditation has matured from the orig inal methodology which based the institutional evaluation on specific minimum requirements such as endowment, size o f library, number o f academic departments, size o f classes, and num ber o f credit hours for graduation. Although such specificity may have been approrpriate for an earlier era, the development o f similar standards today would, in essence, evaluate and standardize education on a basis o f relatively unimportant factors. The Council on Dental Education con curs with this view and, therefore, has developed the “Requirements” to reflect education per missiveness within the confines o f responsible judgment.
650 ■ REPORTS OFCOUNCILS AND BUREAUS I JADA, Vol. 83, September 1971