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The education of an orthodontist
THE
EDUCATION
HAROLD d. Noms,
OF AN ORTHODONTIST L).IJ.S.,
M.D., PORTLAXD. ORE.
I
T IS not my purpose to add more printer’s ink to the discussion of underWith the exception of the Curriculum graduate orthodontic education. I3 program at the University of California, there has been no successful attempt to educate a specialist in orthodontics while he is an undergraduate dental student, and the California plan is essentially a graduate course introduced in the undergraduate years by eliminating selected courses provided by the conventional curriculum leading to a D.D.S. degree. Moreover, I am going to avoid t,hc controversial question of the wisdom or necessity of general practice of dentistry as a prercyuisitc for specialization in orthodontics, other than to say that I do not feel that it is essential to have a complete dental course as understood by the Council on Dental E;ducation or to engage in the general practice of dentistry. Sor do T think that either experience is detrimental to the orthodontist. There is good evidence that a predcntal educational cxpcrience of two baccalaureate years is less to bc recommended than one of three or four yea,rs. I say this because 1 consider t,hc st,aturc of an or*t,hodont,ist in terms of a mature and useful member of societ,y >is well i1s iIll cffcctivcl practitioner in his chosen field. Tie should have the foundation kuowlcdgc t,o make judgmcnt with respect to the social, political, alld cnlturill problems which confront him as well as the self-contained ~‘csourc~s to I)rovidc i~d.justtnent and contentment in his life without complctc~ dcpt~ndenc~c~L~~OII the recreational t’acilit,ies which he can purchase with the dollars that he (lar1Is. You are now aware of t,hc supplern~~~~tal meaning which I have incorporated in the wor$l orthodontist. This is beyond t,hc definition of a contemporary dictionaq-, and you NIT as l’rccl to rc,ject as I am to introduce the concept that is presented to pou in this discussion. For t,he purpose before LIS, I consider an orthodontist to he one who is an ethical and capable practitioner; one who is interested in research, if not actively engaged in it; one who is concerned in advancing his own knowledge and, whenever possible, contributing to the knowledge of others: one who is not satisfied with less than the best; one who holds the interests of his patient above his own; and one who contributes to his community and to the commonwealth in which he lives. you may say, “ lAook here, Noyes, you can’t, add these qualifications to an accepted
Presented before the I’acific Coast Society of Orthodontists, P’cb. 26, 1968, Santa &,rbara, California.
Volume 44 Number 9
EDUCATION
OF AN
ORTHODONTIST
649
I can in this presentation, as long as I provide you with the additives, in the sameway that I am not required to say an ethical orthodontist eachtime term.”
that, I use the word. It is not that orthodontists who fail to meet these standards are unknown to me, but that those with whom I have been most intimately associated have exceeded them. You will note that while speaking of education, I have not used the word training. Here again I chose to m.ake a distinction. While there are phases of an orthodontist’s education which demand training, the over-all experience is education. The student may bo trained to form bands, take impressions, and make a tracing of a headplate, but.he cannot be trained to understand anatomy, comprehend the physiology of the facial mechanism, or grasp the phenomenon of facial growth. Thus, we are dealing with broad aspects of education when we think of educating an orthodontist. TYPES
OF ORTHODONTIC
EDUCATION
There is no one road that leads to the education of an orthodontist. There have been men who have traveled the uphill path of trial and error. Some have been assisted along this road by postgraduate courses. I shall say a word about this instruction lat.er. Largely, in times past, preceptorship training-and here, I believe, the term is used wisely-has served its purpose. In this connection, I am in a position to speak with a background of some experience, for this is the avenue through which I entered the specialty. Obviously, the value of this route is dependent upon the preceptor and t,he apprcntice. There can be effective and dedicated preceptors. Yet, at its best, preceptorship training cannot compete with graduate education. Preceptorship training is an outmoded educational method for which there is no defendable support today. If there had been graduate education at the time I decided to enter orthodontics, I would have been a better practitioner for having benefited from such a course. If I had a son who was contemplating exclusive orthodontic practice, I would urge him with all the persuasive power T possess to enter a graduate course. Following a good graduate course in orthodontics, a preceptorship may be a real value, for the clinical limitations of graduate instruction are supported by experience; likewise, the mot,ivation and inspiration of a good preceptor may contribute in great measure to the neophite as he comes to grips with the problems presented by his profcssion, but they seldom provide the Soundation. As orthodontics has struggled through a half-century of search for a satisfactory educational method for those who specialize in this interesting field, it has, relatively speaking, come to an early and successful solution. It, is my firm belief that the graduate courses are serving very creditably, We may take issue with one or another, but the young men who have come under my observation in recent years are a credit to the profession of orthodontics, and I know of no other technique or process of education which can show as high a rate of success. And when I say this, I am using the concept of orthodontists
650
EDUCATION
OF AN
ORTHODONTIST
6.51
There is no other discipline which can as satisfactorily regiment the fundamental sciences that are assembled in the university-anatomy, physiology, chemistry, bacteriology, physical growth, dental materials, oral pathology, and others. This does not consider the wealth of clinical material which has been accumulated and grows in volume from year to year. The graduate has a springboard start which cannot be duplicated in any other way. No trial-and-error method, no postgraduate course, and no private office can hope to compete with the resources of the university. If the student does not avail himself of his opportunity, it can scarcely be said that he will do more when his opportunities are less, When we consider the training aspects of orthodontic education, the postgraduate course, the short course, and the preceptorship methods may compare more favorably with graduate instruction. This, again, depends upon the quality and discipline of instructors and the length of time that they have In appliance techniques, the short course and contact with their students. l~rcceptor training may be very good-intensive in the former and continued drilling in the latter. In both, it is likely to bc limited to a particular appliance therapy. This criticism may be leveled at some graduate courses. Obviously, no method can include all the various appliances and modifications It is possible to consider the essential met,hcreof that are current today. chanics of tooth-moving devices and their synopsis into a few, at least, of the organized and successful appliance assemblies. In orthodontic practice th(arc is today no appliance system as was known twenty-five years ago. I rcfrr to the lingual arch, the ribbon arch, and the edgewise arch techniques. Thcsc and others arc all modifictl-some wisely, others less rationally. case analysis techniqurs fall into the training class. Because of the time element, graduate instruction has some advantage in presenting various mct,hods, but it holds no corner on this market. There has been too great, a tendency t,o reduce case analysis to formulas, which in some measure may be necessary when teaching students without experience. Pet, with respect, to analysis of the cephalometric x-ray, thi.s has proceeded to the point where t,he immature orthodontist often cannot set the structure for the planes and angles. There is created a slide-rule diagnostician, and some years of oxpericnce may transpire before judgment replaces rule of thumb. I have been amused, when list,cning to recent graduates discuss their problems, to hear one say that the angle is thus and such so we extract four premolars. In reality, L am not. too critical of this didacticism because it has bcrn a crutch upon which the young orthodontist can lean before his clinical .jutlgment will support him. ~11 analysis of records and some knowledge of photography are arra.s of training that may be acquired. in any method of preparation for practice. Again I favor the graduate course for by and large this material will be better organized and more comprehensively presented, though this need not be the case.
652 ISTAKGIBLE
ELEMESTS
OF
ORTHODONTIC
EDUCATION
Returning again to t,he broader aspects of maturation of an orthodontist, there are certain facets of this process t,ha,t are not presented in texts or assignments, one of which generates from the discussion and exchange of ideas hetwctin students. The sparing of intellects between two or more alert Young students interested in a common subject to which there are several planes of thought, may bc more protluctivc~ than N wr~k of lccturcs. This presupposc~s Hcrc again t,he graduate instrnct~ion that the participants have an intcllr~t. give t,he sustained ophas the advantage bccausc~ th(b short ~urs(~ does not portunity for thcsc discussions. and thcl apprentice hils limited eontact,s. ()I’ all forccls which Earlier the inspiration of t,he ttxachrr was mcnt~ionetl. join t,ogcthrr to creat,e an orthodontist: this is paramount,. Here there is no It is a matter of inspiraor ducation. advantage of ow rtlcthotl of training tion, of motivation, of lighting a fire which burns I’or ;I lifctimr. This may happen in a moment! an hour, or, \vherc the tinder takes longer t,o ignite. a month or more. Most of us have had tc~achrrs, or at Irast one teacher, who have started a fire within us. In som(~ that firca burns today ; in another, l~rhaps, several personalities have cont.ributetl th(L inspiration which iml~elled him t,o drive himself to ;Ic~ornplishrnc~Ht ant1 service. In these days when the complrsitirs of our cvcrytl;ty life bewilder us, the orthodontist’s social ant1 professional rrsponsibilitJy may atrophy and become sterile. This responsibility is w privilege which we share wit,h men of all professions. Whrrc this quality is lost in the mU.ss ol’ our professional discipline, I shall not attempt, to analyze, hut it should bc maintained and cultivated in the c&cation of an orthodontist.
I have attempted t,o sketch For YOU my concept of 2111orthodontist and to indicate certain methods that have born created t,o train and educate him. It is my considered opinion that, while none arc without some measure of benefit and all rely essentially upon the quality of student ant1 teacher, the facilities and tlisciplinc of graduate instruction arc distinctly most succcssFu1 in attaining these objcctivcs. ing
The particular are implemented
advantages of th(h short course ant1 apprenticeship trainwhen they are superimposed upon graduate education.
Some of the elements of orthodontic ducation have gested, as well as certain essential, though less Formalized the stature of an orthodontist. Pinally, this specialist can be (~reatcd, but he cannot letters on an offi~ door or nicJlnbership in a society will dontist.
been briefly contributions,
sugto
be lrgislatetl. (:ol(l not make an ortho-
REFFRENCM’ 1 1. Hro(lie, 2. Hrodie,
Allan G.: Graduate Work in Orthodontia, .I. I). Educ. 2: 226.233, 1938. Allan G.: Report of Education Committee, American Association of Ortho(lontists, 1954, AM. J. ORTHOIKWW:S40: 944-946, 1954.
EDUCATION
Volume 44 Number 9
3. Lewis,
OF AN
ORTHODONTIST
Samuel J.: The Development of Orthodontic 1152-1165, 1934. 4. Munblatt, Albert M.: Orthodontic Education Within
Education,
653 J. Am. Dent.
the Scheme of Dental
J. ORTHODONTICS 35: 521-529, 1949. Some Observations on the Progress of Orthodontics 5. Peterson, Howard W.: Past Fifty Years, AM. J. ORTHODONTICS 39: 287-299, 1953. 6. Ross, John W.: Orthodontic Education, AM. J. ORTHODONTICS 34: 259-263,
A. 21:
Education,
AM.
611 S. W.
CAMPUS
DR.
During 1948.
the
EDUCATION
HAROLD d. Noms,
OF AN ORTHODONTIST L).IJ.S.,
M.D., PORTLAXD. ORE.
I
T IS not my purpose to add more printer’s ink to the discussion of underWith the exception of the Curriculum graduate orthodontic education. I3 program at the University of California, there has been no successful attempt to educate a specialist in orthodontics while he is an undergraduate dental student, and the California plan is essentially a graduate course introduced in the undergraduate years by eliminating selected courses provided by the conventional curriculum leading to a D.D.S. degree. Moreover, I am going to avoid t,hc controversial question of the wisdom or necessity of general practice of dentistry as a prercyuisitc for specialization in orthodontics, other than to say that I do not feel that it is essential to have a complete dental course as understood by the Council on Dental E;ducation or to engage in the general practice of dentistry. Sor do T think that either experience is detrimental to the orthodontist. There is good evidence that a predcntal educational cxpcrience of two baccalaureate years is less to bc recommended than one of three or four yea,rs. I say this because 1 consider t,hc st,aturc of an or*t,hodont,ist in terms of a mature and useful member of societ,y >is well i1s iIll cffcctivcl practitioner in his chosen field. Tie should have the foundation kuowlcdgc t,o make judgmcnt with respect to the social, political, alld cnlturill problems which confront him as well as the self-contained ~‘csourc~s to I)rovidc i~d.justtnent and contentment in his life without complctc~ dcpt~ndenc~c~L~~OII the recreational t’acilit,ies which he can purchase with the dollars that he (lar1Is. You are now aware of t,hc supplern~~~~tal meaning which I have incorporated in the wor$l orthodontist. This is beyond t,hc definition of a contemporary dictionaq-, and you NIT as l’rccl to rc,ject as I am to introduce the concept that is presented to pou in this discussion. For t,he purpose before LIS, I consider an orthodontist to he one who is an ethical and capable practitioner; one who is interested in research, if not actively engaged in it; one who is concerned in advancing his own knowledge and, whenever possible, contributing to the knowledge of others: one who is not satisfied with less than the best; one who holds the interests of his patient above his own; and one who contributes to his community and to the commonwealth in which he lives. you may say, “ lAook here, Noyes, you can’t, add these qualifications to an accepted
Presented before the I’acific Coast Society of Orthodontists, P’cb. 26, 1968, Santa &,rbara, California.
Volume 44 Number 9
EDUCATION
OF AN
ORTHODONTIST
649
I can in this presentation, as long as I provide you with the additives, in the sameway that I am not required to say an ethical orthodontist eachtime term.”
that, I use the word. It is not that orthodontists who fail to meet these standards are unknown to me, but that those with whom I have been most intimately associated have exceeded them. You will note that while speaking of education, I have not used the word training. Here again I chose to m.ake a distinction. While there are phases of an orthodontist’s education which demand training, the over-all experience is education. The student may bo trained to form bands, take impressions, and make a tracing of a headplate, but.he cannot be trained to understand anatomy, comprehend the physiology of the facial mechanism, or grasp the phenomenon of facial growth. Thus, we are dealing with broad aspects of education when we think of educating an orthodontist. TYPES
OF ORTHODONTIC
EDUCATION
There is no one road that leads to the education of an orthodontist. There have been men who have traveled the uphill path of trial and error. Some have been assisted along this road by postgraduate courses. I shall say a word about this instruction lat.er. Largely, in times past, preceptorship training-and here, I believe, the term is used wisely-has served its purpose. In this connection, I am in a position to speak with a background of some experience, for this is the avenue through which I entered the specialty. Obviously, the value of this route is dependent upon the preceptor and t,he apprcntice. There can be effective and dedicated preceptors. Yet, at its best, preceptorship training cannot compete with graduate education. Preceptorship training is an outmoded educational method for which there is no defendable support today. If there had been graduate education at the time I decided to enter orthodontics, I would have been a better practitioner for having benefited from such a course. If I had a son who was contemplating exclusive orthodontic practice, I would urge him with all the persuasive power T possess to enter a graduate course. Following a good graduate course in orthodontics, a preceptorship may be a real value, for the clinical limitations of graduate instruction are supported by experience; likewise, the mot,ivation and inspiration of a good preceptor may contribute in great measure to the neophite as he comes to grips with the problems presented by his profcssion, but they seldom provide the Soundation. As orthodontics has struggled through a half-century of search for a satisfactory educational method for those who specialize in this interesting field, it has, relatively speaking, come to an early and successful solution. It, is my firm belief that the graduate courses are serving very creditably, We may take issue with one or another, but the young men who have come under my observation in recent years are a credit to the profession of orthodontics, and I know of no other technique or process of education which can show as high a rate of success. And when I say this, I am using the concept of orthodontists
650
EDUCATION
OF AN
ORTHODONTIST
6.51
There is no other discipline which can as satisfactorily regiment the fundamental sciences that are assembled in the university-anatomy, physiology, chemistry, bacteriology, physical growth, dental materials, oral pathology, and others. This does not consider the wealth of clinical material which has been accumulated and grows in volume from year to year. The graduate has a springboard start which cannot be duplicated in any other way. No trial-and-error method, no postgraduate course, and no private office can hope to compete with the resources of the university. If the student does not avail himself of his opportunity, it can scarcely be said that he will do more when his opportunities are less, When we consider the training aspects of orthodontic education, the postgraduate course, the short course, and the preceptorship methods may compare more favorably with graduate instruction. This, again, depends upon the quality and discipline of instructors and the length of time that they have In appliance techniques, the short course and contact with their students. l~rcceptor training may be very good-intensive in the former and continued drilling in the latter. In both, it is likely to bc limited to a particular appliance therapy. This criticism may be leveled at some graduate courses. Obviously, no method can include all the various appliances and modifications It is possible to consider the essential met,hcreof that are current today. chanics of tooth-moving devices and their synopsis into a few, at least, of the organized and successful appliance assemblies. In orthodontic practice th(arc is today no appliance system as was known twenty-five years ago. I rcfrr to the lingual arch, the ribbon arch, and the edgewise arch techniques. Thcsc and others arc all modifictl-some wisely, others less rationally. case analysis techniqurs fall into the training class. Because of the time element, graduate instruction has some advantage in presenting various mct,hods, but it holds no corner on this market. There has been too great, a tendency t,o reduce case analysis to formulas, which in some measure may be necessary when teaching students without experience. Pet, with respect, to analysis of the cephalometric x-ray, thi.s has proceeded to the point where t,he immature orthodontist often cannot set the structure for the planes and angles. There is created a slide-rule diagnostician, and some years of oxpericnce may transpire before judgment replaces rule of thumb. I have been amused, when list,cning to recent graduates discuss their problems, to hear one say that the angle is thus and such so we extract four premolars. In reality, L am not. too critical of this didacticism because it has bcrn a crutch upon which the young orthodontist can lean before his clinical .jutlgment will support him. ~11 analysis of records and some knowledge of photography are arra.s of training that may be acquired. in any method of preparation for practice. Again I favor the graduate course for by and large this material will be better organized and more comprehensively presented, though this need not be the case.
652 ISTAKGIBLE
ELEMESTS
OF
ORTHODONTIC
EDUCATION
Returning again to t,he broader aspects of maturation of an orthodontist, there are certain facets of this process t,ha,t are not presented in texts or assignments, one of which generates from the discussion and exchange of ideas hetwctin students. The sparing of intellects between two or more alert Young students interested in a common subject to which there are several planes of thought, may bc more protluctivc~ than N wr~k of lccturcs. This presupposc~s Hcrc again t,he graduate instrnct~ion that the participants have an intcllr~t. give t,he sustained ophas the advantage bccausc~ th(b short ~urs(~ does not portunity for thcsc discussions. and thcl apprentice hils limited eontact,s. ()I’ all forccls which Earlier the inspiration of t,he ttxachrr was mcnt~ionetl. join t,ogcthrr to creat,e an orthodontist: this is paramount,. Here there is no It is a matter of inspiraor ducation. advantage of ow rtlcthotl of training tion, of motivation, of lighting a fire which burns I’or ;I lifctimr. This may happen in a moment! an hour, or, \vherc the tinder takes longer t,o ignite. a month or more. Most of us have had tc~achrrs, or at Irast one teacher, who have started a fire within us. In som(~ that firca burns today ; in another, l~rhaps, several personalities have cont.ributetl th(L inspiration which iml~elled him t,o drive himself to ;Ic~ornplishrnc~Ht ant1 service. In these days when the complrsitirs of our cvcrytl;ty life bewilder us, the orthodontist’s social ant1 professional rrsponsibilitJy may atrophy and become sterile. This responsibility is w privilege which we share wit,h men of all professions. Whrrc this quality is lost in the mU.ss ol’ our professional discipline, I shall not attempt, to analyze, hut it should bc maintained and cultivated in the c&cation of an orthodontist.
I have attempted t,o sketch For YOU my concept of 2111orthodontist and to indicate certain methods that have born created t,o train and educate him. It is my considered opinion that, while none arc without some measure of benefit and all rely essentially upon the quality of student ant1 teacher, the facilities and tlisciplinc of graduate instruction arc distinctly most succcssFu1 in attaining these objcctivcs. ing
The particular are implemented
advantages of th(h short course ant1 apprenticeship trainwhen they are superimposed upon graduate education.
Some of the elements of orthodontic ducation have gested, as well as certain essential, though less Formalized the stature of an orthodontist. Pinally, this specialist can be (~reatcd, but he cannot letters on an offi~ door or nicJlnbership in a society will dontist.
been briefly contributions,
sugto
be lrgislatetl. (:ol(l not make an ortho-
REFFRENCM’ 1 1. Hro(lie, 2. Hrodie,
Allan G.: Graduate Work in Orthodontia, .I. I). Educ. 2: 226.233, 1938. Allan G.: Report of Education Committee, American Association of Ortho(lontists, 1954, AM. J. ORTHOIKWW:S40: 944-946, 1954.
EDUCATION
Volume 44 Number 9
3. Lewis,
OF AN
ORTHODONTIST
Samuel J.: The Development of Orthodontic 1152-1165, 1934. 4. Munblatt, Albert M.: Orthodontic Education Within
Education,
653 J. Am. Dent.
the Scheme of Dental
J. ORTHODONTICS 35: 521-529, 1949. Some Observations on the Progress of Orthodontics 5. Peterson, Howard W.: Past Fifty Years, AM. J. ORTHODONTICS 39: 287-299, 1953. 6. Ross, John W.: Orthodontic Education, AM. J. ORTHODONTICS 34: 259-263,
A. 21:
Education,
AM.
611 S. W.
CAMPUS
DR.
During 1948.
the