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The Dental School in the Educational Continuum
The dental sch o ol in the edu cation al continuum
Sheldon Rovin, DDS, MS, Lexington, Ky
A m ultiple track system allows a student to pursue liberal arts study in conjunction w ith dental school, and accepts field experience for course credit. The dental curriculum should be flexible enough to grant advanced placement to qualified students and to allow students to progress at th eir own pace. Faculty members of dental schools should work w ith university faculty members to provide adequate counseling fo r students.
The idea of a curriculuar continuum between liberal arts and dental colleges is an old one, but like many ideas propounded ahead o f their time, it requires the accumulation of a critical mass of support and advocacy before it can be imple mented. Well, that critical mass has been achieved and the notion o f interdigitation of pre professional and professional curriculums in one form or another is accepted by many who give serious thought to health education reform.1'6 N ow it is time to get on with it. My objective is to posit the dental school cur riculum in this continuum, both conceptually and practically. First, I shall examine and, hopeful ly, dispel some of the misapprehensions and myths that have kept dental education from play ing a proper role in the continuum. Second, I shall suggest a number of actions which would immediately bring dental education into the con tinuum.
D entistry as a p p lied biology
Dentistry is no more a distinct science than are medicine, pharmacy, and nursing. Dentistry, like
the other health professions, draws on a number of basic sciences for its dimension and cannot lay claim to being anything except an applied discipline. Specifically, dentistry is applied biol ogy. The sooner this concept is accepted, the easier it will be to bring dental education into its proper perspective. If it is agreed that dentistry is an applied science, then where the basic science is learned should be immaterial. Learning basic science in high school or college offers no special disad vantage to the student. A student can learn bio chemistry along with English or sociology. If there is a genuine desire to integrate the pre professional and professional curriculums, the place to begin is with the basic sciences. H ow ever, this will require change in the attitudes of dental educators and strong support from den tal school administrators; more precisely, it will be imperative for us to abolish the parochial ism that basic sciences can be learned only or best in dental school.
T h e stu d en t as an individual
Dental educators generally consider students as parts of a class whose progress is measured in years. The class is promoted from the first to the second or the freshman to the sophomore year, and so on. Repeats are often for the entire year even though the student is deficient only in a particular, identifiable area. The tacit or per haps overt assumption is that students generally are the same. The absurdity in this view surely must be apparent. In any class o f 50 students there are 50 different levels or kinds of ability, incentive, interest, background, learning style, academic preparation, and social outlook— not to mention genetic attributes. Y et we con tinue to treat all students the same by teaching them in the same way over the same period of time, even to the point of requiring students to study subjects in dental school in which they JADA, Vol. 84, May 1972 ■ 1063
are already proficient. I suspect that what was just said is not really new information. I further suspect that we deal with students as if they were all identical for reasons born of convenience and tradition. It is simpler to teach students collectively than indi vidually. It is easier to structure learning experi ences for a class than for individual students. It is simpler, but it is also considerably less effec tive and pedagogically unsound. Educational re search is rife with studies that demonstrate the correlation between effective teaching and the recognition of individual differences among stu dents.7 The concept o f individualized instruction is for eign to the current generation of dental educa tors, but it must not remain so if dental educa tion is to be effective, relevant, and part of an educational continuum, circa 1971. Considering that an American public school system of approx imately 22,000 students from grades 1 to 12 successfully initiated an individualized instruc tion program,8 should not dental schools, with considerably fewer students and a much lower student-faculty ratio, be able to do as much?
The science oriented predental curriculum A third concept, as prevalent as it is falla cious, is that a plethora of science in the pre professional curriculum is a prerequisite to suc cess in dental school. There is a lack of sup porting evidence for this supposition and, in fact, the little available evidence suggests some thing different. One study shows no correlation between the quantity of science taken in the pre dental curriculum and the degree of success in the basic sciences taken in dental school.9 The same study indicates that if a student shows pro ficiency in some predental science he is likely to do well in the science courses taken in dental school; taking additional science seems not to make a difference. A study with medical students shows no statistically significant differ ences in attrition rates between students with science and nonscience premedical majors.10 Some empiric evidence, although scanty, comes from my own institution where last year we en rolled, on an experimental basis, three students who had no biology courses before taking gross anatomy in the dental school. The three students, 1064 ■ JADA, Vol. 84, May 1972
competing with the regular dental class, received a C, B, and A , and the performance o f the A student was the second best in the class.
Student achievement: quality vs quantity Another tenet which bears examination is that somehow time in school and success as a stu dent are closely related. This assumption applies to preprofessional as well as to professional edu cation. I would venture that there are a num ber of high school students perfectly capable of negotiating even the most arduous o f dental cur riculums. A s an experiment, five senior high school students in the Lexington school system took the Dental Aptitude Test in the spring of 1971. They were superior students, but only one was oriented toward dentistry. The D A T is geared at assessing junior college students, but all o f these high school students were within one standard deviation of the national average. A t the same time I would suggest that there are some students incapable o f negotiating the simplest of dental curriculums after four years or more o f liberal arts education. The point is that the quality o f the student is important, not his years or time spent in school. Some people insist that the student must spend a certain time in predental study to become the well rounded, “ whole” man. Perhaps! I am not aware of evidence that a course in literature or music, for example, produces appreciation of literature or music later in life. To my knowl edge there is little to suggest that a student with four years of liberal arts education will have more social consciousness than a two-year student. A person’s interests are developed by the quality of what he is exposed to, not the quantity. Becoming well-rounded may be more a function o f the individual and his upbringing than anything else. The basis for appreciation o f en vironment, culture, and education is laid else where than in classrooms, at least as they are currently constituted. Those who fear that shortening the educa tional continuum will result in a narrower, less well-rounded person fail to consider that much of what they learned in college currently is taught in high school or earlier, or outside the school entirely.11 These skeptics did not grow up with the extracurricular education provided by the
constant bombardment of television and other media that depict the environment, our culture, and our societal problems, lucidly and with im pact, if not with total accuracy. Breadth and edu cational longevity are not necessary correlates. If they were, most of our health professionals would be omniscient.
Dental colleges as part of the university? M ost dental schools and medical centers are in tegral components of universities, at least physi cally. Conceptually, it may be another matter. My experience as chairman of a university sen ate has shown me that many campus faculty view medical center faculty as supercilious, con ceited, narrow, and highly overpaid. Some feel that medical centers have no place in a university. On the other hand, many medical center fac ulty consider campus faculty to be picayunish, slow, and intellectually pompous. Some would just as soon sever all affiliations with the campus. It is painfully obvious that such feelings are not conducive to the best interests of any con tinuum between liberal arts and health educa tion. It should be equally apparent that no ef fective continuum can be constructed without willing and enthusiastic effort by everyone con cerned. If the differences between the groups are not resolved and if the mutual distrust is not dissipated, the student will suffer. In our zealous guarding of vested interests we forget that it is the student for whom we labor and whose interests should be served. It should be clear that an educational continuum is very much in the interests o f the student and will even tuate in better dental graduates.
Proposed solutions The foregoing was a sort o f iconoclastic incur sion on some of the canons of the dental educa tional academy which I believe are impediments to achieving an educational continuum. There is, however, a need for more than mere criticism. Ways to eliminate these hindrances must be found and concrete actions must be taken to bring the dental curriculum and dental education into the continuum. In the remainder of this paper, then, I shall propose such actions.
■ R e s p o n s i b il it ie s
o f a d m is s io n s
c o m m it te e s :
Dental school admissions committees should ac cept students on their merits and should place emphasis on how well students learn rather than what they have learned. Reaching a given point in the educational con tinuum in terms o f courses taken or years ex pended should not necessarily be required for admission to dental school. Recognizing this, the A D A H ouse of Delegates rescinded the former list o f predental requirements during their 1970 meeting. What should be required is that a student reach a point in the continuum where he has learned how to learn and where he can demon strate independent acquisition o f knowledge and can evaluate information for its quality, useful ness and relevance. Indexes of these learning attributes include participation in honors pro grams, research projects, and independent studies, and they should be sought in dental school applicants. A concomitant of the foregoing is that entry into dental school should occur in a variety of ways, depending on the caliber of student. A mul tiple track system of predental education «that varies in length and content was formulated by a committee at our institution which, incidentally, included the dean o f undergraduate studies.5 This system, which was accepted by the faculty of the College of Dentistry, allows for entry into dental school directly after high school or at any given point during undergraduate education. Superior students can pursue as much or as little undergraduate study in any area as they wish, and early entrants are able to continue their liberal arts study as they proceed through dental school. At the same time, the system al lows for exit and reentry at several levels. The multiple track system enables recognition o f the myriad differences among students be cause it caters to individual interest and ability and has as its basis a rigorous educational ex perience, irrespective of subjects studied. A music or sociology major, for example, would have the same chance for admission to dental school as a science major. The system also incorporates educational and “ broadening” experiences outside of the class room by allowing field experiences such as the Peace Corps, Vista, work-study programs, and the like to be substituted for course offerings. The classroom may soon no longer be the pri mary arena for study. Consider, if you will, Rovin: DENTAL SCHOOL IN THE EDUCATIONAL CONTINUUM ■ 1065
where art is best learned, in class or in a mu seum? Can students learn sociology better in a classroom or in a ghetto or Peace Corps setting? For that matter, do dental students learn more about dental practice in the clinics o f a dental school, as externs in dental offices, or in insti tutions where the delivery of health care is their only business? This sytem, with its flexibility and individu ality, is not without hazard, the chief one being the manner of assessing students. The rise or fall of the system will be contingent on our ability to rate student ability, deficiency, and maturity earlier than in the past. The onus of assessment falls squarely on the shoulders o f dental school admissions commit tees, but this burden would be mitigated appre ciably if the committees included willing faculty from associated liberal arts colleges. This should be possible generally since most dental schools are part of a university. A liaison of this sort would be a healthy venture and doubtless would help cement the flagging relationships between the campus and medical center. ■ A dvanced placem ent: Students should be ad mitted to dental school at a level commensur ate with their ability and previous education. There is no justification for compelling students to study what they already know. Many stu dents in health profession schools have had courses in college and occasionally in high school which covered the same material pre sented in one or more of their basic science courses. Advanced placement is an accepted procedure that obviates duplication, and ad vanced placement examinations are used suc cessfully by hundreds of colleges; they require no more effort to prepare than a final examina tion. The educational continuum we are striv ing for would be well served if students who accelerated their education in college could con tinue to do so in dental school. H owever, ad vanced placement should not be limited to su perior students. Any dental student who so de sires should have the opportunity to be exempted from courses that he can pass by examination. ■ Individual progress: Dental school curricu lums should be structured to allow individual students to progress at their own pace. Students from honors programs or independent studies in liberal arts colleges would be disserved if after entrance into dental school they were compelled 1066 ■ JADA, Vol. 84, May 1972
to proceed at a slower pace than before. The same would be true for students following one of the described predental tracks leading to early entrance. It would be educationally disastrous to permit students to accelerate through the first part of an educational continuum only to be slowed later. The paramount issue is that all students should be given the chance to progress at their own pace. Empiric data from an individualized course in oral pathology at our institution showed that average students in terms of grade point stand ing did better or as well in significantly less time than a control group of students taught with conventional methods. This study indicates that students may vary in performance depending on what learning method is used. Thus, an indi vidualized curriculum with an opportunity for students to choose from several learning methods appears to be in the best interests of all students. There are several medical schools with varying degrees o f individualization in their curriculums, and more programs are being planned.3,6 Many liberal arts colleges are doing the sam e.11 At the time of this writing our College o f Dentistry has individualized about a third o f its curricu lum. And, happily, there are indications of simi lar activities from at least a few other dental schools. ■ Faculty participation: Dental school faculty should actively participate in the undergraduate educational program and in the affairs of the uni versity. An immediate and, hopefully, obvious role for dental school faculty is in advising undergrad uates, especially those who have identified, or are inclined toward, dentistry as a career choice. At the very least they should serve as consultants or auxiliary advisors to the existing cadre of campus faculty advisors. In this capacity dental school faculty could offer a special kind o f preparation for dentistry not found in class by imparting a realistic view of what dentistry and dental school are all about. They could help in the selection of courses and programs, evaluate students for admission to dental school, and counsel students out of dentistry when it is apparent that their interests or talents would be served best in an other endeavor. The salutary effect on the rela tionships between campus and dental school faculty from this kind o f participation is obvious. A second role for dental educators is partici pation in the overall affairs o f their universities.
Professional colleges are not immune to the ef fects of educational policies affecting undergrad uate education. The deliberations o f university committees and senates are enhanced when input is made from the spectrum o f talent that resides in a university, regardless of discipline. Unfortunately, the health professional schools seem to want it all one way. Recently, I was asked by a group of medical center faculty, “ What do universities contribute to medical cen ters?” Although they judiciously neglected the converse of that question, I answered briefly by enumerating the services performed by uni versity computing centers, libraries, communica tions centers, educational resource people, ad missions offices which include a gamut of test ing and counseling contributions, housing for stu dents, recreational and cultural opportunities for faculty and students, a variety of educational op portunities, not to mention the salaries for fac ulty and staff, equipment and space. Finally, I suggested that one additional contribution, in tangible but important, is the intellectual cli mate o f a university which plays a major role in attracting health professionals into education. Medical center faculty should be willing to give some of their time and talents to solving the problems that beset the universities. Without collaboration among all faculty, the university will flounder and all will suffer, the medical center and campus alike.
Summary The groves of academe are being shaken by an onslaught of what appear to be new prob lems. In reality these problems are not new, but only seem so because they concern issues which transcend the holy trinity of teaching, research, and service, and thus are alien to many educa tors. These problems are those of delivery of educational services to an increasingly large num
ber of consumers while at the same time recog nizing the need of individuals to realize their potential. An educational continuum that one can enter and exit and reenter according to ability and interest seems a reasonable approach. The role of the dental school in this continuum is important. But to bring dental education into the continuum requires some changes. We must stop looking at new problems with old eyes; we must take steps that may be unfamiliar and, hence, discomforting to many o f us. This paper is a pro posal for a beginning.
Presented at a conference entitled, "E ducational C ontinuum fo r Dental Careers,” in Philadelphia, Oct 9, 1971, sponsored by the American Association of Dental Schools and the American Dental Association. Dr. Rovin is director, Planning, Development, and Evaluation, University of Kentucky College of Dentistry, Lexington, Ky 40506.
1. D arlington, J.M. Reflections on preprofessional advising. J Dent Educ 35:7 Jan 1971. 2. Grobstein, C. Toward fully university-based health profes sional schools. J Med Educ 45:684 Sept 1970. 3. Carnegie Commission on Higher Education. Higher educa tion and the nation's health— policies fo r m edical and dental education. New York, M cGraw-Hill, O ct 1970. 4. Kimball, C.P. The challenge o f m edicine in the ’70s. Health care through education. JAMA 216:2124 June 28,1971. 5. Report o f the ad hoc com m ittee on predental curriculum . Lexington, University o f Kentucky C olle g e o f Dentistry, May 1971. 6. Lee, P.V. Current changes in collegiate education affect ing health professional education. Presented at the 46th annual session o f the AADS, Houston, March 1969. 7. Rovin, S., and Packer, M.W. Evaluation o f teaching and teachers at the University of Kentucky College o f Dentistry: I. Development of evaluation criteria. J Dent Educ 35:496 Aug 1971. 8. Esbensen, T. W orking w ith individualized instruction. Palo Alto, Fearon Publishers, 1968. 9. Smith, T.A., and Hill, G.W. The correlation o f perform ance in basic sciences in dental school w ith predental science ex perience. Unpublished. 10. Johnson, D.G., and H utchins, E.B. D octor o r dropout, a study of medical student a ttritio n .J Med Educ 41:1099 Dec 1966. 11. Carnegie Comm ission on Higher Education. Less time, more options— education beyond the high school. New York, McGraw-Hill, Jan 1971.
Rovin: DENTAL SCHOOL IN THE EDUCATIONAL CONTINUUM ■ 1067
Sheldon Rovin, DDS, MS, Lexington, Ky
A m ultiple track system allows a student to pursue liberal arts study in conjunction w ith dental school, and accepts field experience for course credit. The dental curriculum should be flexible enough to grant advanced placement to qualified students and to allow students to progress at th eir own pace. Faculty members of dental schools should work w ith university faculty members to provide adequate counseling fo r students.
The idea of a curriculuar continuum between liberal arts and dental colleges is an old one, but like many ideas propounded ahead o f their time, it requires the accumulation of a critical mass of support and advocacy before it can be imple mented. Well, that critical mass has been achieved and the notion o f interdigitation of pre professional and professional curriculums in one form or another is accepted by many who give serious thought to health education reform.1'6 N ow it is time to get on with it. My objective is to posit the dental school cur riculum in this continuum, both conceptually and practically. First, I shall examine and, hopeful ly, dispel some of the misapprehensions and myths that have kept dental education from play ing a proper role in the continuum. Second, I shall suggest a number of actions which would immediately bring dental education into the con tinuum.
D entistry as a p p lied biology
Dentistry is no more a distinct science than are medicine, pharmacy, and nursing. Dentistry, like
the other health professions, draws on a number of basic sciences for its dimension and cannot lay claim to being anything except an applied discipline. Specifically, dentistry is applied biol ogy. The sooner this concept is accepted, the easier it will be to bring dental education into its proper perspective. If it is agreed that dentistry is an applied science, then where the basic science is learned should be immaterial. Learning basic science in high school or college offers no special disad vantage to the student. A student can learn bio chemistry along with English or sociology. If there is a genuine desire to integrate the pre professional and professional curriculums, the place to begin is with the basic sciences. H ow ever, this will require change in the attitudes of dental educators and strong support from den tal school administrators; more precisely, it will be imperative for us to abolish the parochial ism that basic sciences can be learned only or best in dental school.
T h e stu d en t as an individual
Dental educators generally consider students as parts of a class whose progress is measured in years. The class is promoted from the first to the second or the freshman to the sophomore year, and so on. Repeats are often for the entire year even though the student is deficient only in a particular, identifiable area. The tacit or per haps overt assumption is that students generally are the same. The absurdity in this view surely must be apparent. In any class o f 50 students there are 50 different levels or kinds of ability, incentive, interest, background, learning style, academic preparation, and social outlook— not to mention genetic attributes. Y et we con tinue to treat all students the same by teaching them in the same way over the same period of time, even to the point of requiring students to study subjects in dental school in which they JADA, Vol. 84, May 1972 ■ 1063
are already proficient. I suspect that what was just said is not really new information. I further suspect that we deal with students as if they were all identical for reasons born of convenience and tradition. It is simpler to teach students collectively than indi vidually. It is easier to structure learning experi ences for a class than for individual students. It is simpler, but it is also considerably less effec tive and pedagogically unsound. Educational re search is rife with studies that demonstrate the correlation between effective teaching and the recognition of individual differences among stu dents.7 The concept o f individualized instruction is for eign to the current generation of dental educa tors, but it must not remain so if dental educa tion is to be effective, relevant, and part of an educational continuum, circa 1971. Considering that an American public school system of approx imately 22,000 students from grades 1 to 12 successfully initiated an individualized instruc tion program,8 should not dental schools, with considerably fewer students and a much lower student-faculty ratio, be able to do as much?
The science oriented predental curriculum A third concept, as prevalent as it is falla cious, is that a plethora of science in the pre professional curriculum is a prerequisite to suc cess in dental school. There is a lack of sup porting evidence for this supposition and, in fact, the little available evidence suggests some thing different. One study shows no correlation between the quantity of science taken in the pre dental curriculum and the degree of success in the basic sciences taken in dental school.9 The same study indicates that if a student shows pro ficiency in some predental science he is likely to do well in the science courses taken in dental school; taking additional science seems not to make a difference. A study with medical students shows no statistically significant differ ences in attrition rates between students with science and nonscience premedical majors.10 Some empiric evidence, although scanty, comes from my own institution where last year we en rolled, on an experimental basis, three students who had no biology courses before taking gross anatomy in the dental school. The three students, 1064 ■ JADA, Vol. 84, May 1972
competing with the regular dental class, received a C, B, and A , and the performance o f the A student was the second best in the class.
Student achievement: quality vs quantity Another tenet which bears examination is that somehow time in school and success as a stu dent are closely related. This assumption applies to preprofessional as well as to professional edu cation. I would venture that there are a num ber of high school students perfectly capable of negotiating even the most arduous o f dental cur riculums. A s an experiment, five senior high school students in the Lexington school system took the Dental Aptitude Test in the spring of 1971. They were superior students, but only one was oriented toward dentistry. The D A T is geared at assessing junior college students, but all o f these high school students were within one standard deviation of the national average. A t the same time I would suggest that there are some students incapable o f negotiating the simplest of dental curriculums after four years or more o f liberal arts education. The point is that the quality o f the student is important, not his years or time spent in school. Some people insist that the student must spend a certain time in predental study to become the well rounded, “ whole” man. Perhaps! I am not aware of evidence that a course in literature or music, for example, produces appreciation of literature or music later in life. To my knowl edge there is little to suggest that a student with four years of liberal arts education will have more social consciousness than a two-year student. A person’s interests are developed by the quality of what he is exposed to, not the quantity. Becoming well-rounded may be more a function o f the individual and his upbringing than anything else. The basis for appreciation o f en vironment, culture, and education is laid else where than in classrooms, at least as they are currently constituted. Those who fear that shortening the educa tional continuum will result in a narrower, less well-rounded person fail to consider that much of what they learned in college currently is taught in high school or earlier, or outside the school entirely.11 These skeptics did not grow up with the extracurricular education provided by the
constant bombardment of television and other media that depict the environment, our culture, and our societal problems, lucidly and with im pact, if not with total accuracy. Breadth and edu cational longevity are not necessary correlates. If they were, most of our health professionals would be omniscient.
Dental colleges as part of the university? M ost dental schools and medical centers are in tegral components of universities, at least physi cally. Conceptually, it may be another matter. My experience as chairman of a university sen ate has shown me that many campus faculty view medical center faculty as supercilious, con ceited, narrow, and highly overpaid. Some feel that medical centers have no place in a university. On the other hand, many medical center fac ulty consider campus faculty to be picayunish, slow, and intellectually pompous. Some would just as soon sever all affiliations with the campus. It is painfully obvious that such feelings are not conducive to the best interests of any con tinuum between liberal arts and health educa tion. It should be equally apparent that no ef fective continuum can be constructed without willing and enthusiastic effort by everyone con cerned. If the differences between the groups are not resolved and if the mutual distrust is not dissipated, the student will suffer. In our zealous guarding of vested interests we forget that it is the student for whom we labor and whose interests should be served. It should be clear that an educational continuum is very much in the interests o f the student and will even tuate in better dental graduates.
Proposed solutions The foregoing was a sort o f iconoclastic incur sion on some of the canons of the dental educa tional academy which I believe are impediments to achieving an educational continuum. There is, however, a need for more than mere criticism. Ways to eliminate these hindrances must be found and concrete actions must be taken to bring the dental curriculum and dental education into the continuum. In the remainder of this paper, then, I shall propose such actions.
■ R e s p o n s i b il it ie s
o f a d m is s io n s
c o m m it te e s :
Dental school admissions committees should ac cept students on their merits and should place emphasis on how well students learn rather than what they have learned. Reaching a given point in the educational con tinuum in terms o f courses taken or years ex pended should not necessarily be required for admission to dental school. Recognizing this, the A D A H ouse of Delegates rescinded the former list o f predental requirements during their 1970 meeting. What should be required is that a student reach a point in the continuum where he has learned how to learn and where he can demon strate independent acquisition o f knowledge and can evaluate information for its quality, useful ness and relevance. Indexes of these learning attributes include participation in honors pro grams, research projects, and independent studies, and they should be sought in dental school applicants. A concomitant of the foregoing is that entry into dental school should occur in a variety of ways, depending on the caliber of student. A mul tiple track system of predental education «that varies in length and content was formulated by a committee at our institution which, incidentally, included the dean o f undergraduate studies.5 This system, which was accepted by the faculty of the College of Dentistry, allows for entry into dental school directly after high school or at any given point during undergraduate education. Superior students can pursue as much or as little undergraduate study in any area as they wish, and early entrants are able to continue their liberal arts study as they proceed through dental school. At the same time, the system al lows for exit and reentry at several levels. The multiple track system enables recognition o f the myriad differences among students be cause it caters to individual interest and ability and has as its basis a rigorous educational ex perience, irrespective of subjects studied. A music or sociology major, for example, would have the same chance for admission to dental school as a science major. The system also incorporates educational and “ broadening” experiences outside of the class room by allowing field experiences such as the Peace Corps, Vista, work-study programs, and the like to be substituted for course offerings. The classroom may soon no longer be the pri mary arena for study. Consider, if you will, Rovin: DENTAL SCHOOL IN THE EDUCATIONAL CONTINUUM ■ 1065
where art is best learned, in class or in a mu seum? Can students learn sociology better in a classroom or in a ghetto or Peace Corps setting? For that matter, do dental students learn more about dental practice in the clinics o f a dental school, as externs in dental offices, or in insti tutions where the delivery of health care is their only business? This sytem, with its flexibility and individu ality, is not without hazard, the chief one being the manner of assessing students. The rise or fall of the system will be contingent on our ability to rate student ability, deficiency, and maturity earlier than in the past. The onus of assessment falls squarely on the shoulders o f dental school admissions commit tees, but this burden would be mitigated appre ciably if the committees included willing faculty from associated liberal arts colleges. This should be possible generally since most dental schools are part of a university. A liaison of this sort would be a healthy venture and doubtless would help cement the flagging relationships between the campus and medical center. ■ A dvanced placem ent: Students should be ad mitted to dental school at a level commensur ate with their ability and previous education. There is no justification for compelling students to study what they already know. Many stu dents in health profession schools have had courses in college and occasionally in high school which covered the same material pre sented in one or more of their basic science courses. Advanced placement is an accepted procedure that obviates duplication, and ad vanced placement examinations are used suc cessfully by hundreds of colleges; they require no more effort to prepare than a final examina tion. The educational continuum we are striv ing for would be well served if students who accelerated their education in college could con tinue to do so in dental school. H owever, ad vanced placement should not be limited to su perior students. Any dental student who so de sires should have the opportunity to be exempted from courses that he can pass by examination. ■ Individual progress: Dental school curricu lums should be structured to allow individual students to progress at their own pace. Students from honors programs or independent studies in liberal arts colleges would be disserved if after entrance into dental school they were compelled 1066 ■ JADA, Vol. 84, May 1972
to proceed at a slower pace than before. The same would be true for students following one of the described predental tracks leading to early entrance. It would be educationally disastrous to permit students to accelerate through the first part of an educational continuum only to be slowed later. The paramount issue is that all students should be given the chance to progress at their own pace. Empiric data from an individualized course in oral pathology at our institution showed that average students in terms of grade point stand ing did better or as well in significantly less time than a control group of students taught with conventional methods. This study indicates that students may vary in performance depending on what learning method is used. Thus, an indi vidualized curriculum with an opportunity for students to choose from several learning methods appears to be in the best interests of all students. There are several medical schools with varying degrees o f individualization in their curriculums, and more programs are being planned.3,6 Many liberal arts colleges are doing the sam e.11 At the time of this writing our College o f Dentistry has individualized about a third o f its curricu lum. And, happily, there are indications of simi lar activities from at least a few other dental schools. ■ Faculty participation: Dental school faculty should actively participate in the undergraduate educational program and in the affairs of the uni versity. An immediate and, hopefully, obvious role for dental school faculty is in advising undergrad uates, especially those who have identified, or are inclined toward, dentistry as a career choice. At the very least they should serve as consultants or auxiliary advisors to the existing cadre of campus faculty advisors. In this capacity dental school faculty could offer a special kind o f preparation for dentistry not found in class by imparting a realistic view of what dentistry and dental school are all about. They could help in the selection of courses and programs, evaluate students for admission to dental school, and counsel students out of dentistry when it is apparent that their interests or talents would be served best in an other endeavor. The salutary effect on the rela tionships between campus and dental school faculty from this kind o f participation is obvious. A second role for dental educators is partici pation in the overall affairs o f their universities.
Professional colleges are not immune to the ef fects of educational policies affecting undergrad uate education. The deliberations o f university committees and senates are enhanced when input is made from the spectrum o f talent that resides in a university, regardless of discipline. Unfortunately, the health professional schools seem to want it all one way. Recently, I was asked by a group of medical center faculty, “ What do universities contribute to medical cen ters?” Although they judiciously neglected the converse of that question, I answered briefly by enumerating the services performed by uni versity computing centers, libraries, communica tions centers, educational resource people, ad missions offices which include a gamut of test ing and counseling contributions, housing for stu dents, recreational and cultural opportunities for faculty and students, a variety of educational op portunities, not to mention the salaries for fac ulty and staff, equipment and space. Finally, I suggested that one additional contribution, in tangible but important, is the intellectual cli mate o f a university which plays a major role in attracting health professionals into education. Medical center faculty should be willing to give some of their time and talents to solving the problems that beset the universities. Without collaboration among all faculty, the university will flounder and all will suffer, the medical center and campus alike.
Summary The groves of academe are being shaken by an onslaught of what appear to be new prob lems. In reality these problems are not new, but only seem so because they concern issues which transcend the holy trinity of teaching, research, and service, and thus are alien to many educa tors. These problems are those of delivery of educational services to an increasingly large num
ber of consumers while at the same time recog nizing the need of individuals to realize their potential. An educational continuum that one can enter and exit and reenter according to ability and interest seems a reasonable approach. The role of the dental school in this continuum is important. But to bring dental education into the continuum requires some changes. We must stop looking at new problems with old eyes; we must take steps that may be unfamiliar and, hence, discomforting to many o f us. This paper is a pro posal for a beginning.
Presented at a conference entitled, "E ducational C ontinuum fo r Dental Careers,” in Philadelphia, Oct 9, 1971, sponsored by the American Association of Dental Schools and the American Dental Association. Dr. Rovin is director, Planning, Development, and Evaluation, University of Kentucky College of Dentistry, Lexington, Ky 40506.
1. D arlington, J.M. Reflections on preprofessional advising. J Dent Educ 35:7 Jan 1971. 2. Grobstein, C. Toward fully university-based health profes sional schools. J Med Educ 45:684 Sept 1970. 3. Carnegie Commission on Higher Education. Higher educa tion and the nation's health— policies fo r m edical and dental education. New York, M cGraw-Hill, O ct 1970. 4. Kimball, C.P. The challenge o f m edicine in the ’70s. Health care through education. JAMA 216:2124 June 28,1971. 5. Report o f the ad hoc com m ittee on predental curriculum . Lexington, University o f Kentucky C olle g e o f Dentistry, May 1971. 6. Lee, P.V. Current changes in collegiate education affect ing health professional education. Presented at the 46th annual session o f the AADS, Houston, March 1969. 7. Rovin, S., and Packer, M.W. Evaluation o f teaching and teachers at the University of Kentucky College o f Dentistry: I. Development of evaluation criteria. J Dent Educ 35:496 Aug 1971. 8. Esbensen, T. W orking w ith individualized instruction. Palo Alto, Fearon Publishers, 1968. 9. Smith, T.A., and Hill, G.W. The correlation o f perform ance in basic sciences in dental school w ith predental science ex perience. Unpublished. 10. Johnson, D.G., and H utchins, E.B. D octor o r dropout, a study of medical student a ttritio n .J Med Educ 41:1099 Dec 1966. 11. Carnegie Comm ission on Higher Education. Less time, more options— education beyond the high school. New York, McGraw-Hill, Jan 1971.
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