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Seeking dental education innovation
Seeking dental education innovation Background.—It is commonly accepted that any organization that refuses to change is destined to fail. Dr. W. Edwards Deming was a consultant to Japanese industry in the 1950s and 1960s and theorized that continual improvement is essential to success. As a result, the Japanese changed how they made cars and now Toyota has surpassed General Motors as the world’s largest car manufacturer. Toyota continually improved product quality until even those most loyal to American cars saw the difference. The effects of continual improvement are less impressive than those of innovation, which gives customers something they didn’t know they needed or wanted or revolutionizes how a product or service is made or delivered. The Apple iPod is a product innovation; Web site auctioning of no-longer-needed stuff is a service innovation. Originality also influences success. Built on tradition, originality is a choice to depart from it. An original approach violates the audience’s expectations while upholding and endorsing those expectations.
support continual improvement, but do not routinely expect it or give it high priority. Current accreditation standards require processes supporting continual improvement, implying that all accredited institutions have them. If no continual improvement is occurring, the accreditation process is flawed or the pace, approach, or degree of change is damaged.
Business education differentiates improvement from innovation. Continual improvement is essential to a business’ survival; continual innovation is essential to its success. The dictionary definition of innovation emphasizes presenting an idea, method, or device in a new way, whereas the business school definition emphasizes newness that is unexpected but embraced by the consumer, a definition similar to Deming’s concept.
Calls for change have promoted initial expectations set too high to be readily attainable. Attempts are being made to move dental education away from rigid passive learning techniques but educators are not all convinced that a serious problem exists. While we recognize that active learning is superior to passive learning for most topics, acting on that belief requires more thought, time, and personnel than passive learning. Thus dental educators may choose not to adopt active learning approaches out of fear, laziness, or a lack of leadership where they teach. Focusing just on dental school graduates makes it hard to see fundamental problems. Today’s graduates can readily command 6-figure incomes the day they graduate and soon reach income levels older practitioners never thought possible. This makes arguments that the education system is failing dental students seem inadequate.
These ideas are relevant to the American Dental Education Association (ADEA). The ADEA portrays academic dentistry as at a crossroads. It implies dental education (at least that offered at major universities) is severely damaged and could die without innovation. Specifically, it has not progressed with the new trends and challenges of the dental profession. The criticism stops with vague ideas of the problem and buzzwords. Defining the Problem.—Current dental curriculum is bloated, provides inadequate time for students to achieve true clinical competence, impedes faculty from undertaking meaningful research, and relies on an unsustainable economic model. Dental leaders met to ‘‘deconstruct’’ the dental curriculum, especially the first 2 years, and recommended eliminating topics or moving them into the college curriculum as prerequisites. Many left the meeting seeing the problem more clearly but with no consensus on the solution. Significant changes in dental education move slowly, with lack of enthusiasm most likely the result of misunderstanding the situation itself. Dental deans generally
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Dental Abstracts
Call for Change.—Calls for change were initially made in forums not amenable to discussion, debate, or questioning. Leaders assumed everyone agreed and delivered the call in a condescending manner. They failed to adequately document the shortfalls in dental education and conduct a widespread dialogue about how to fix the situation, so no enthusiasm for change arose. Innovation is supposed to be part of the process even when the system is not badly broken, but this rarely occurs. Dental faculties may respond better if reassured that changes will be original but founded on traditional values and goals.
Why Change Is Needed.—Generational issues and emerging science are the two situations on which calls for change are based. Although the generations clearly differ, particularly in how they prefer to and are best equipped to learn, most educators support active learning and are not resistant to change. New scientific discoveries that may alter dental practice occur in such areas as genomics and nontechnology. However, true dental practice changes over the past 20 years are relatively few. Calling for dental students to receive basic science education alongside medical students is not innovative or particularly reflective of changes in medicine. Much basic science education is not retained beyond initial licensure testing. Dental educators
are blessed to know the specific anatomic area graduates will focus on and can extensively teach about the physiology and diseases of that area as well as the scope of care the graduates will be licensed to practice. Dental basic sciences can be delivered in depth where needed and covered less intensively for more peripheral body areas. This reflects a ‘‘need to know’’ versus a ‘‘nice to know’’ approach. Critical thinking skills are essential in dental education. It could be argued that the best educational approach is to train students to think critically, use evidence to justify clinical decisions, and know the terms needed to read and understand sources of new information, then focus on teaching only the clinical therapeutic skills currently in regular use by dentists. There would be no need for basic science teaching at all. Do dentists really need to know renal physiology or anatomy? How in-depth should the presentation be? What information should we leave for the student to look up because it is readily available in textbooks or likely to change? What should the student have to memorize? Recommendations.—If the goal is true originality, dental educators must assess the depths of the content they present, what students can and should learn on their own, and what judgment, diagnostic, and therapeutic skills are needed to produce an excellent dentist. Deconstruction of the current curriculum is unlikely to be successful because dental educators prefer a substantial degree of self-
determination and because we still don’t know how to replace its broken parts. These factors mitigate against setting up a national curriculum. No substantial changes will occur as long as new dental graduates are successful with the training currently provided. Any new strategy must address how the dentist of 2020 and 2030 will deliver needed health care. Rather than teaching information for information’s sake, dental education will be most successful if it teaches the application of information, an area currently lacking. Right now we are turning bright, excited college students into cynical, learn-only-what-is-needed drones who can barely wait for graduation.
Clinical Significance.—Knowledge, expanding at an ever-increasing pace, impacts all disciplines. New materials and techniques, plus the effect of advances in basic sciences on clinical practice, hearken for change in the dental curriculum, but where and to what degree? What needs to be known and what is nice to know?
Hupp J: Innovation in dental education: Empty buzzword or real movement? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:1-4, 2008 Reprints not available
EXTRACTS I CAN HEAR YOU. Brain imaging shows that even heavily sedated people can hear and process speech, although they cannot fully comprehend or remember it. Deep sedation inactivates the brain areas that serve the conscious awareness of speech and the ability to store sentences in memory. The study was conducted at Cambridge University to determine how the brain responds to speech as sedation increases and whether people can still understand speech when consciousness and memory are impaired. [Sedated Patients Hear, Can’t Understand. AGD Impact, February 2008, p 21]
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support continual improvement, but do not routinely expect it or give it high priority. Current accreditation standards require processes supporting continual improvement, implying that all accredited institutions have them. If no continual improvement is occurring, the accreditation process is flawed or the pace, approach, or degree of change is damaged.
Business education differentiates improvement from innovation. Continual improvement is essential to a business’ survival; continual innovation is essential to its success. The dictionary definition of innovation emphasizes presenting an idea, method, or device in a new way, whereas the business school definition emphasizes newness that is unexpected but embraced by the consumer, a definition similar to Deming’s concept.
Calls for change have promoted initial expectations set too high to be readily attainable. Attempts are being made to move dental education away from rigid passive learning techniques but educators are not all convinced that a serious problem exists. While we recognize that active learning is superior to passive learning for most topics, acting on that belief requires more thought, time, and personnel than passive learning. Thus dental educators may choose not to adopt active learning approaches out of fear, laziness, or a lack of leadership where they teach. Focusing just on dental school graduates makes it hard to see fundamental problems. Today’s graduates can readily command 6-figure incomes the day they graduate and soon reach income levels older practitioners never thought possible. This makes arguments that the education system is failing dental students seem inadequate.
These ideas are relevant to the American Dental Education Association (ADEA). The ADEA portrays academic dentistry as at a crossroads. It implies dental education (at least that offered at major universities) is severely damaged and could die without innovation. Specifically, it has not progressed with the new trends and challenges of the dental profession. The criticism stops with vague ideas of the problem and buzzwords. Defining the Problem.—Current dental curriculum is bloated, provides inadequate time for students to achieve true clinical competence, impedes faculty from undertaking meaningful research, and relies on an unsustainable economic model. Dental leaders met to ‘‘deconstruct’’ the dental curriculum, especially the first 2 years, and recommended eliminating topics or moving them into the college curriculum as prerequisites. Many left the meeting seeing the problem more clearly but with no consensus on the solution. Significant changes in dental education move slowly, with lack of enthusiasm most likely the result of misunderstanding the situation itself. Dental deans generally
230
Dental Abstracts
Call for Change.—Calls for change were initially made in forums not amenable to discussion, debate, or questioning. Leaders assumed everyone agreed and delivered the call in a condescending manner. They failed to adequately document the shortfalls in dental education and conduct a widespread dialogue about how to fix the situation, so no enthusiasm for change arose. Innovation is supposed to be part of the process even when the system is not badly broken, but this rarely occurs. Dental faculties may respond better if reassured that changes will be original but founded on traditional values and goals.
Why Change Is Needed.—Generational issues and emerging science are the two situations on which calls for change are based. Although the generations clearly differ, particularly in how they prefer to and are best equipped to learn, most educators support active learning and are not resistant to change. New scientific discoveries that may alter dental practice occur in such areas as genomics and nontechnology. However, true dental practice changes over the past 20 years are relatively few. Calling for dental students to receive basic science education alongside medical students is not innovative or particularly reflective of changes in medicine. Much basic science education is not retained beyond initial licensure testing. Dental educators
are blessed to know the specific anatomic area graduates will focus on and can extensively teach about the physiology and diseases of that area as well as the scope of care the graduates will be licensed to practice. Dental basic sciences can be delivered in depth where needed and covered less intensively for more peripheral body areas. This reflects a ‘‘need to know’’ versus a ‘‘nice to know’’ approach. Critical thinking skills are essential in dental education. It could be argued that the best educational approach is to train students to think critically, use evidence to justify clinical decisions, and know the terms needed to read and understand sources of new information, then focus on teaching only the clinical therapeutic skills currently in regular use by dentists. There would be no need for basic science teaching at all. Do dentists really need to know renal physiology or anatomy? How in-depth should the presentation be? What information should we leave for the student to look up because it is readily available in textbooks or likely to change? What should the student have to memorize? Recommendations.—If the goal is true originality, dental educators must assess the depths of the content they present, what students can and should learn on their own, and what judgment, diagnostic, and therapeutic skills are needed to produce an excellent dentist. Deconstruction of the current curriculum is unlikely to be successful because dental educators prefer a substantial degree of self-
determination and because we still don’t know how to replace its broken parts. These factors mitigate against setting up a national curriculum. No substantial changes will occur as long as new dental graduates are successful with the training currently provided. Any new strategy must address how the dentist of 2020 and 2030 will deliver needed health care. Rather than teaching information for information’s sake, dental education will be most successful if it teaches the application of information, an area currently lacking. Right now we are turning bright, excited college students into cynical, learn-only-what-is-needed drones who can barely wait for graduation.
Clinical Significance.—Knowledge, expanding at an ever-increasing pace, impacts all disciplines. New materials and techniques, plus the effect of advances in basic sciences on clinical practice, hearken for change in the dental curriculum, but where and to what degree? What needs to be known and what is nice to know?
Hupp J: Innovation in dental education: Empty buzzword or real movement? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:1-4, 2008 Reprints not available
EXTRACTS I CAN HEAR YOU. Brain imaging shows that even heavily sedated people can hear and process speech, although they cannot fully comprehend or remember it. Deep sedation inactivates the brain areas that serve the conscious awareness of speech and the ability to store sentences in memory. The study was conducted at Cambridge University to determine how the brain responds to speech as sedation increases and whether people can still understand speech when consciousness and memory are impaired. [Sedated Patients Hear, Can’t Understand. AGD Impact, February 2008, p 21]
Volume 53 Issue 5 2008
231