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Hospital-based program of advanced endodontic education
FEATURE
WORKSHOP OF ADVANCED ENDODONTIC PROGRAMS T h e W o r k s h o p of A d v a n c e d E n d o d o n t i c P r o g r a m s w a s h e l d in C h i c a g o , F e b 21-22, 1975. T h e o b j e c t i v e s of t h e W o r k s h o p w e r e to establish clearly defined criteria and guidelines that will enable e v a l u a t o r s to d i s t i n g u i s h a m o n g t h e v a r i e t i e s of p r o g r a m s c u r r e n t l y b e i n g o f f e r e d a n d t h o s e in t h e p l a n n i n g s t a g e s . P r o c e e d i n g s of G r o u p 4, l e d b y I. B. B e n d e r , is the fifth of a s e r i e s of p o s i t i o n p a p e r s . T h r e e i n t r o d u c t o r y p a p e r s a n d p r o c e e d i n g s of G r o u p s 1 a n d 2 a p p e a r e d r e s p e c t i v e l y in the O c t o b e r , N o v e m b e r , a n d D e c e m b e r 1975 i s s u e s of the J o u r n a l . P r o c e e d i n g s of G r o u p 3 a p p e a r e d in t h e J a n u a r y 1976 i s s u e .
H o s p i t a l - b a s e d p r o g r a m of advanced endodontic education I. B. Bender, DDS Charles Cunningham, DDS, Recorder
F o r many years dental schools have been the only institutions qualified to train dental students. With the development of specialization, they have also become the training bases to prepare specialists to serve our society. In the last decade, another institution has emerged in the training of specialists and paradental personnel--the hospital. Hospitals have been recognized for many years by the American Dental Association and, more recently, by many dental schools as an area rich in resources of teaching materials. A number of schools have seen fit to incorporate these resources into their teaching
38
programs. They also realize that the direction of their growth in the near future is toward designing dental health care delivery systems that include hospital programs. Not all hospitals can provide comprehensive dental health care, especially not such services as endodontics. Speci~tlty hospitals, small hospitals, or proprietary hospitals, or even large general hospitals that do not have general dentistry residency programs cannot academically support endodontic training programs. The best institutions are the large medical centers. These can provide a continuous large flow of patients
with a diversity of pathologic cases from both the out-patient and inpatient departments of the hospital. Moreover, the trustees or the hospital administration are cognizant that dentistry and the specific specialties are essential in the structure of a medical complex that can deliver total health care to the community.
Advantages Of the many advantages of a graduate program offered by such a hospital, the student is brought into an environment that includes all the health services (physicians, dentists, specialists, nurses, paramedical, and
JOURNAL OF ENDODONTICS I VOL 2, NO 2, FEBRUARY 1976
paradental personnel) with the express prupose of delivering total health care to the community. The entire structure of the health unit is based on the philosophy that the patient is the most important person in the hospital. This concept is not always grasped in the dental school environment. The student's exposure to hospital surroundings makes him acutely aware of the interplay of all the health sciences and of how they are brought to bear on health implementation and the dehvery of services. The trainee becomes an integral part of a team of health scientists that renders necessary services. On completion of his training, the student tends to develop a greater sense of social consciousness and responsibility to the community. The exposure in school to the basic sciences of physiology, anatomy, and pathology, which were difficult for the student to comprehend in their clinical applications, crystallizes into a meaningful clinical significance. The student becomes motivated into action, applying what he has learned from his lectures and books. He no longer thinks in terms of drill-andfill. By exposure to other parameters of medicine, he begins to synthesize information from these diverse fields. Furthermore, he enriches his limited medical jargon and background of complications that may follow certain procedures. He tends to develop a more balanced clinical judgment of when and when not to operate. He becomes a more mature clinician, rather than a technician. Exposure to operating room procedures and decorum becomes another exciting experience. The observations of the preparation and application of anesthesia, intubation, administration of intravenous sedation with constant monitoring of the condition of the patient, brings the
application of these procedures out of the realm of the textbook and into the reality of clinical application. The demand for excellence becomes pervasive, and there is a strong motivational force to learn. Performing endodontics in an operating-room atmosphere focuses attention on the need for greater knowledge than was gained in school. What seemed so unimportant, such as a history, physical and medical evaluation, and laboratory tests, becomes of crucial importance in this environment. Furthermore, performing endodontics under such conditions demands resourceful modification in the application of the principles of endodontics. Other advantages of hospital programs are that they are less rigid and less dogmatic than are school programs. Under a hospital program, the learning process is more stimulating and has a tendency to develop independent thinking. Such advantages can be provided by experienced practioners who have realized over the years the shortcomings of a rigid program. In a hospital environment, the student has a better opportunity to enhance his background in biologic sciences from various medical disciplines. The atmosphere is conducive to an exchange of interpersonal communication between disciplines. Much of the latest information can be obtained by asking questions or in discussions with immunologists, pathologists, radiologists, and other dental specialists. Clinical pathologic conferences is another means whereby a student can enrich his fabric of knowledge. The treatment of the physically handicapped or chronically ill patients in schools is very limited or nonexistent. It has been estimated that from 8% to 10% of our population is composed of the physically
disabled, and another substantial segment is mentally handicapped. In a hospital program, the student is exposed to special procedures that deliver such comprehensive dental services. Furthermore, exposure to the behavioral sciences in the institution helps one develop a greater empathy for all patients. A more specific advantage to the student of endodontics is that he encounters a large number of trauma cases. Patients with traumatic injuries are more disposed to seek treatment in the accident ward of a hospital than in a school. The student sees a much larger number of dental emergencies and facial pain syndromes that require greater diagnostic acumen to differentiate between pain of dental and nondental origin. Because of a 24-hour-coverage commitment with independent responsibilities, the resident becomes professionally selfreliant and mature at a more rapid rate. In addition, since hospital programs are for a period of 24 months instead of the usual two academic years of school programs, the student treats a greater number of clinical cases. Many hospital programs offer stipends up to $15,000 per year to residents in endodontics. Other hospital programs have arrangements with schools whereby the resident only pays a $1,000 tuition fee to the school for the basic science curriculum. This economic advantage is greater than the scholarships that may be offered by schools. Disadvantaqes
While a hospital-based program may have some worthwhile advantages, there are numerous disadvantages. The difficulty in developing qualified teaching personnel is one. Since the teaching services are usually unremunerative, it is difficult to hold the staff accountable for its 39
JOURNAL OF ENDODONTIC$ I VOL 2, NO 2, FEBRUARY 1976
teaching responsibilities and assignments. The better qualified instructors seek to identify themselves with schools. Evidently, they feel the association with a school gives them more stature in their community or a greater "psychic" income. As a result, hospital programs may lack good supervision. A n o t h e r disadvantage of hospital programs is that a smaller number of students are admitted, usually one or two candidates. With this smaller number, there is less academic intercommunication or cross fertilization, an advantage of larger classes. With large groups, there is a greater chance of selecting students from different schools. The student, therefore, can bring different concepts and philosophies into the learning atmosphere. These advantages of ntlmbers and quality of matriculants from differcnt schools are denied to hospital programs. A third disadvantage is that the hospital programs usually do not offer opportunities for advanced degrees; however, some do by special arrangement. Some students who may be interested in teaching or research tend to gravitate toward the school programs. A fourth disadvantage is that budget allocations are assigned to the more critical services of a hospital. Since dentistry is of lower priority than is the surgical division, for example, improvements or replacement of dental equipment are often delayed. Quite often hospitals are located at great distances from schools or medical centers. This is yet another disadvantage because the trainee, therefore, loses time traveling to his basic science courses or special lectures.
Analysis After an analysis of the advantages and disadvantages of hospital-based
40
programs, it becomes obvious that many of the advantages cannot be incorporated into a school program. But. the disadvantages can be modified to improve the hospital program. Improvement of both programs can be achieved by amalgamation. An affiliation of the school and hospital programs should be established to improve the educational experience, The advantages of the two programs can be achieved by a rotational system, Two or three students could be assigned for a designated period to the exposure of the advantages of the hospital program. To negate some of the disadvantages, members of the school faculty could be rotated to the hospital clinic. This rotation can give the faculty an opportunity to become acquainted with the hospital environment.
Evaluation of Proqram In evaluating a hospital program, one of the considerations for the site inspectors is to know who is in charge of the training program. The person in charge should be a diplomate of the American Board of Endodontics; the attending staff should be comprised, at least, of educationally Board-qualified endodontists. The hospital should have enough resource material to insure a continuous flow of patients in the outpatient department. The institution should serve a community that demands or desires endodontic services and not just oral surgery or trauma cases. When a site inspection of a particular institutiorf is contemplated, the chairman of the dental department and the chief of the endodontic division should be informed to arrange a time to meet with the administrator of the hospital. A brief, personal interview should be held with the administrator or executive vicepresident of the hospital to determine
the particular status and the attitude toward the dental department and the respective specialties in the hospital. This type of information will indicate to the site inspectors the attitude toward dentistry. The inspection committee should inspect the general facilities of the hospital, such as the various laboratories, X-ray department, operating room suite, research facilities, and the library. The library should be examined as to the number of texts and periodicals. Examination of all these facilities will give insight to the relative condition and space assigned to the dental department as compared with other departments. The dental department should be well equipped with modern equipment in bright surroundings. The department should have at least four to five chairs and sufficient X-ray machines (well insulated from radiation exposure). Each endodontic resident should have access to at least one dental operatory at any one time. Numerous sinks should be available at various stations in the clinic, and autoclaves for instrument sterilization should be at hand. The endodontic stations should be well equipped with all the necessary equipment, such as salt sterilizers, high-speed units, suction apparatus, lights, and units carrying endodontic instruments. Enough space should be available to perform endodontics and surgical procedures. Questions by inspectors should be directed toward the ordering of special equipment and the method of reordering of standard supplies. One should note the number of general practice residents present and the quality of treatment performed within the department. The inspectors are to determine whether the endodontic postgraduate students participate in teaching the general practice residents (interns). It is necessary
JOURNAL OF ENDODONTICS [ VOL 2, NO 2, FEBRUARY 1976
to determine what type of instruction
is emphasized, whether it is endodontic surgery only or complete endodontic procedures. Is the teaching on a one-to-one basis, or is the trainee required to prepare special lectures for instruction? These types of questions help discern the type of teaching experience. Discussions are then held with the department head about what arrangements have been made for the postgraduate student to avail himself of the basic science curriculum. Contact should be established with the faculty of the basic sciences of the school or the faculty of the medical center that offers the program to evaluate the subjects that are taught and the number of hours that are assigned for each topic. It is not a good policy to accept the core-curriculum program as presented in the printed bulletin. Many changes occur in faculties from the time of printing to the time of program evaluation. After examination of the hospital and the dental department, the examiners are ready for the more important part of the evaluation--interviewing the trainees and examining the treatment files. A request should be made by the examiners to look through the files and select a random representative number of cases undergoing current and past treatment and the cases in the special file (hemisections, root amputations, replants, apexifications). Particular attention should be given to the presentation of the history, clinical examination, diagnosis, quality of radiographs, and follow-up evaluation.
Each graduate student is interviewed separately in a private room. The following questions may be asked. - - D o e s the program fulfill their expectations? - - D o they treat enough cases to give them proficiency? - - A r e there enough varied cases of surgery, combined periodontic-endodontic lesions, replantations, trauma cases, and emergencies? - - C a n they avail themselves of histopathologic reports, and can they examine the slides? - - D o e s the department head meet with them regularly? - - D o e s the department head or any other faculty member attempt to correlate basic science instruction with clinical practice to give them a background of biologic therapy? - - D o e s the visiting staff member report regularly as to their assignments? - - A r e clinical demonstrations and surgical procedures performed by the instructional staff for trainee instruction? - - A r e there any literature review sessions with the chief of service or other member of the staff? - - H o w often, if ever, do they hold seminars? - - D o they have an effective recall system? - - A r e the supplies of endodontic instruments adequate? - - D o they keep records of the various cases? - - A r e special cases kept in a separate file? - - W h a t are the weaknesses and the strong points in the program? What
suggestions can they offer for improvement? The foregoing interview should be repeated with each student to get the most representative sample for analysis of the program. An examination of the documented records will determine the quality of performance of the student, the quality of instruction at the institution, and the number of cases treated by each student. The examiner should not offer any criticism or enter into any discussion that concerns the program. He shotild only ask questions that will elicit further information. This type of comprehensive examination should not be exclusive to hospital programs. There are many school programs that also need such evaluation. The foregoing evaluation of the hospital facilities and the questionnaire analysis can serve as a basis in the determination of the quality of a program. What constitutes a superior or inferior program depends on what importance the examiner attaches to his findings. It is essential that the inspector be objective and candid in his evaluation, regardless of his relationship with the chairman of the endodontic department. Moreover, one shouldn't be reluctant to censor a program even if it is an institution cloaked with the mantle of academia. Dr. Bender is professor of endodontics, School of Dental Medicine, University of Pennsylvania. Requests for reprints should be directed to Dr. 1. B. Bender, Benjamin Fox Pavilion, Suite 330, Jenkintown, Pa 19046.
41
WORKSHOP OF ADVANCED ENDODONTIC PROGRAMS T h e W o r k s h o p of A d v a n c e d E n d o d o n t i c P r o g r a m s w a s h e l d in C h i c a g o , F e b 21-22, 1975. T h e o b j e c t i v e s of t h e W o r k s h o p w e r e to establish clearly defined criteria and guidelines that will enable e v a l u a t o r s to d i s t i n g u i s h a m o n g t h e v a r i e t i e s of p r o g r a m s c u r r e n t l y b e i n g o f f e r e d a n d t h o s e in t h e p l a n n i n g s t a g e s . P r o c e e d i n g s of G r o u p 4, l e d b y I. B. B e n d e r , is the fifth of a s e r i e s of p o s i t i o n p a p e r s . T h r e e i n t r o d u c t o r y p a p e r s a n d p r o c e e d i n g s of G r o u p s 1 a n d 2 a p p e a r e d r e s p e c t i v e l y in the O c t o b e r , N o v e m b e r , a n d D e c e m b e r 1975 i s s u e s of the J o u r n a l . P r o c e e d i n g s of G r o u p 3 a p p e a r e d in t h e J a n u a r y 1976 i s s u e .
H o s p i t a l - b a s e d p r o g r a m of advanced endodontic education I. B. Bender, DDS Charles Cunningham, DDS, Recorder
F o r many years dental schools have been the only institutions qualified to train dental students. With the development of specialization, they have also become the training bases to prepare specialists to serve our society. In the last decade, another institution has emerged in the training of specialists and paradental personnel--the hospital. Hospitals have been recognized for many years by the American Dental Association and, more recently, by many dental schools as an area rich in resources of teaching materials. A number of schools have seen fit to incorporate these resources into their teaching
38
programs. They also realize that the direction of their growth in the near future is toward designing dental health care delivery systems that include hospital programs. Not all hospitals can provide comprehensive dental health care, especially not such services as endodontics. Speci~tlty hospitals, small hospitals, or proprietary hospitals, or even large general hospitals that do not have general dentistry residency programs cannot academically support endodontic training programs. The best institutions are the large medical centers. These can provide a continuous large flow of patients
with a diversity of pathologic cases from both the out-patient and inpatient departments of the hospital. Moreover, the trustees or the hospital administration are cognizant that dentistry and the specific specialties are essential in the structure of a medical complex that can deliver total health care to the community.
Advantages Of the many advantages of a graduate program offered by such a hospital, the student is brought into an environment that includes all the health services (physicians, dentists, specialists, nurses, paramedical, and
JOURNAL OF ENDODONTICS I VOL 2, NO 2, FEBRUARY 1976
paradental personnel) with the express prupose of delivering total health care to the community. The entire structure of the health unit is based on the philosophy that the patient is the most important person in the hospital. This concept is not always grasped in the dental school environment. The student's exposure to hospital surroundings makes him acutely aware of the interplay of all the health sciences and of how they are brought to bear on health implementation and the dehvery of services. The trainee becomes an integral part of a team of health scientists that renders necessary services. On completion of his training, the student tends to develop a greater sense of social consciousness and responsibility to the community. The exposure in school to the basic sciences of physiology, anatomy, and pathology, which were difficult for the student to comprehend in their clinical applications, crystallizes into a meaningful clinical significance. The student becomes motivated into action, applying what he has learned from his lectures and books. He no longer thinks in terms of drill-andfill. By exposure to other parameters of medicine, he begins to synthesize information from these diverse fields. Furthermore, he enriches his limited medical jargon and background of complications that may follow certain procedures. He tends to develop a more balanced clinical judgment of when and when not to operate. He becomes a more mature clinician, rather than a technician. Exposure to operating room procedures and decorum becomes another exciting experience. The observations of the preparation and application of anesthesia, intubation, administration of intravenous sedation with constant monitoring of the condition of the patient, brings the
application of these procedures out of the realm of the textbook and into the reality of clinical application. The demand for excellence becomes pervasive, and there is a strong motivational force to learn. Performing endodontics in an operating-room atmosphere focuses attention on the need for greater knowledge than was gained in school. What seemed so unimportant, such as a history, physical and medical evaluation, and laboratory tests, becomes of crucial importance in this environment. Furthermore, performing endodontics under such conditions demands resourceful modification in the application of the principles of endodontics. Other advantages of hospital programs are that they are less rigid and less dogmatic than are school programs. Under a hospital program, the learning process is more stimulating and has a tendency to develop independent thinking. Such advantages can be provided by experienced practioners who have realized over the years the shortcomings of a rigid program. In a hospital environment, the student has a better opportunity to enhance his background in biologic sciences from various medical disciplines. The atmosphere is conducive to an exchange of interpersonal communication between disciplines. Much of the latest information can be obtained by asking questions or in discussions with immunologists, pathologists, radiologists, and other dental specialists. Clinical pathologic conferences is another means whereby a student can enrich his fabric of knowledge. The treatment of the physically handicapped or chronically ill patients in schools is very limited or nonexistent. It has been estimated that from 8% to 10% of our population is composed of the physically
disabled, and another substantial segment is mentally handicapped. In a hospital program, the student is exposed to special procedures that deliver such comprehensive dental services. Furthermore, exposure to the behavioral sciences in the institution helps one develop a greater empathy for all patients. A more specific advantage to the student of endodontics is that he encounters a large number of trauma cases. Patients with traumatic injuries are more disposed to seek treatment in the accident ward of a hospital than in a school. The student sees a much larger number of dental emergencies and facial pain syndromes that require greater diagnostic acumen to differentiate between pain of dental and nondental origin. Because of a 24-hour-coverage commitment with independent responsibilities, the resident becomes professionally selfreliant and mature at a more rapid rate. In addition, since hospital programs are for a period of 24 months instead of the usual two academic years of school programs, the student treats a greater number of clinical cases. Many hospital programs offer stipends up to $15,000 per year to residents in endodontics. Other hospital programs have arrangements with schools whereby the resident only pays a $1,000 tuition fee to the school for the basic science curriculum. This economic advantage is greater than the scholarships that may be offered by schools. Disadvantaqes
While a hospital-based program may have some worthwhile advantages, there are numerous disadvantages. The difficulty in developing qualified teaching personnel is one. Since the teaching services are usually unremunerative, it is difficult to hold the staff accountable for its 39
JOURNAL OF ENDODONTIC$ I VOL 2, NO 2, FEBRUARY 1976
teaching responsibilities and assignments. The better qualified instructors seek to identify themselves with schools. Evidently, they feel the association with a school gives them more stature in their community or a greater "psychic" income. As a result, hospital programs may lack good supervision. A n o t h e r disadvantage of hospital programs is that a smaller number of students are admitted, usually one or two candidates. With this smaller number, there is less academic intercommunication or cross fertilization, an advantage of larger classes. With large groups, there is a greater chance of selecting students from different schools. The student, therefore, can bring different concepts and philosophies into the learning atmosphere. These advantages of ntlmbers and quality of matriculants from differcnt schools are denied to hospital programs. A third disadvantage is that the hospital programs usually do not offer opportunities for advanced degrees; however, some do by special arrangement. Some students who may be interested in teaching or research tend to gravitate toward the school programs. A fourth disadvantage is that budget allocations are assigned to the more critical services of a hospital. Since dentistry is of lower priority than is the surgical division, for example, improvements or replacement of dental equipment are often delayed. Quite often hospitals are located at great distances from schools or medical centers. This is yet another disadvantage because the trainee, therefore, loses time traveling to his basic science courses or special lectures.
Analysis After an analysis of the advantages and disadvantages of hospital-based
40
programs, it becomes obvious that many of the advantages cannot be incorporated into a school program. But. the disadvantages can be modified to improve the hospital program. Improvement of both programs can be achieved by amalgamation. An affiliation of the school and hospital programs should be established to improve the educational experience, The advantages of the two programs can be achieved by a rotational system, Two or three students could be assigned for a designated period to the exposure of the advantages of the hospital program. To negate some of the disadvantages, members of the school faculty could be rotated to the hospital clinic. This rotation can give the faculty an opportunity to become acquainted with the hospital environment.
Evaluation of Proqram In evaluating a hospital program, one of the considerations for the site inspectors is to know who is in charge of the training program. The person in charge should be a diplomate of the American Board of Endodontics; the attending staff should be comprised, at least, of educationally Board-qualified endodontists. The hospital should have enough resource material to insure a continuous flow of patients in the outpatient department. The institution should serve a community that demands or desires endodontic services and not just oral surgery or trauma cases. When a site inspection of a particular institutiorf is contemplated, the chairman of the dental department and the chief of the endodontic division should be informed to arrange a time to meet with the administrator of the hospital. A brief, personal interview should be held with the administrator or executive vicepresident of the hospital to determine
the particular status and the attitude toward the dental department and the respective specialties in the hospital. This type of information will indicate to the site inspectors the attitude toward dentistry. The inspection committee should inspect the general facilities of the hospital, such as the various laboratories, X-ray department, operating room suite, research facilities, and the library. The library should be examined as to the number of texts and periodicals. Examination of all these facilities will give insight to the relative condition and space assigned to the dental department as compared with other departments. The dental department should be well equipped with modern equipment in bright surroundings. The department should have at least four to five chairs and sufficient X-ray machines (well insulated from radiation exposure). Each endodontic resident should have access to at least one dental operatory at any one time. Numerous sinks should be available at various stations in the clinic, and autoclaves for instrument sterilization should be at hand. The endodontic stations should be well equipped with all the necessary equipment, such as salt sterilizers, high-speed units, suction apparatus, lights, and units carrying endodontic instruments. Enough space should be available to perform endodontics and surgical procedures. Questions by inspectors should be directed toward the ordering of special equipment and the method of reordering of standard supplies. One should note the number of general practice residents present and the quality of treatment performed within the department. The inspectors are to determine whether the endodontic postgraduate students participate in teaching the general practice residents (interns). It is necessary
JOURNAL OF ENDODONTICS [ VOL 2, NO 2, FEBRUARY 1976
to determine what type of instruction
is emphasized, whether it is endodontic surgery only or complete endodontic procedures. Is the teaching on a one-to-one basis, or is the trainee required to prepare special lectures for instruction? These types of questions help discern the type of teaching experience. Discussions are then held with the department head about what arrangements have been made for the postgraduate student to avail himself of the basic science curriculum. Contact should be established with the faculty of the basic sciences of the school or the faculty of the medical center that offers the program to evaluate the subjects that are taught and the number of hours that are assigned for each topic. It is not a good policy to accept the core-curriculum program as presented in the printed bulletin. Many changes occur in faculties from the time of printing to the time of program evaluation. After examination of the hospital and the dental department, the examiners are ready for the more important part of the evaluation--interviewing the trainees and examining the treatment files. A request should be made by the examiners to look through the files and select a random representative number of cases undergoing current and past treatment and the cases in the special file (hemisections, root amputations, replants, apexifications). Particular attention should be given to the presentation of the history, clinical examination, diagnosis, quality of radiographs, and follow-up evaluation.
Each graduate student is interviewed separately in a private room. The following questions may be asked. - - D o e s the program fulfill their expectations? - - D o they treat enough cases to give them proficiency? - - A r e there enough varied cases of surgery, combined periodontic-endodontic lesions, replantations, trauma cases, and emergencies? - - C a n they avail themselves of histopathologic reports, and can they examine the slides? - - D o e s the department head meet with them regularly? - - D o e s the department head or any other faculty member attempt to correlate basic science instruction with clinical practice to give them a background of biologic therapy? - - D o e s the visiting staff member report regularly as to their assignments? - - A r e clinical demonstrations and surgical procedures performed by the instructional staff for trainee instruction? - - A r e there any literature review sessions with the chief of service or other member of the staff? - - H o w often, if ever, do they hold seminars? - - D o they have an effective recall system? - - A r e the supplies of endodontic instruments adequate? - - D o they keep records of the various cases? - - A r e special cases kept in a separate file? - - W h a t are the weaknesses and the strong points in the program? What
suggestions can they offer for improvement? The foregoing interview should be repeated with each student to get the most representative sample for analysis of the program. An examination of the documented records will determine the quality of performance of the student, the quality of instruction at the institution, and the number of cases treated by each student. The examiner should not offer any criticism or enter into any discussion that concerns the program. He shotild only ask questions that will elicit further information. This type of comprehensive examination should not be exclusive to hospital programs. There are many school programs that also need such evaluation. The foregoing evaluation of the hospital facilities and the questionnaire analysis can serve as a basis in the determination of the quality of a program. What constitutes a superior or inferior program depends on what importance the examiner attaches to his findings. It is essential that the inspector be objective and candid in his evaluation, regardless of his relationship with the chairman of the endodontic department. Moreover, one shouldn't be reluctant to censor a program even if it is an institution cloaked with the mantle of academia. Dr. Bender is professor of endodontics, School of Dental Medicine, University of Pennsylvania. Requests for reprints should be directed to Dr. 1. B. Bender, Benjamin Fox Pavilion, Suite 330, Jenkintown, Pa 19046.
41