The revitalization of U.S. dental education

Revitalization of dental education in the United States is an imperative, but it depends mainly on the willingness of dental school faculty to make great changes. My remarks address a system of education of dental professionals in relation to other health professionals whose vision seems at times to have surpassed ours. I advocate for a revitalization of our profession in order to stand at the fore when it comes to ensuring the health and well-being of the public. Thanks to advances in molecular medicine, health care is being transformed from a system of treating disease to one that provides predictive, preemptive, and personalized care. This presentation makes recommendations for rethinking the current system of dental education in order to elevate dentistry to its rightful place as a vibrant health care leader. Dental education needs to be a source of new knowledge, discovery, and innovation to sustain its legacy as a learned profession. Graduates must be lifelong learners who can critically evaluate science and technology for the good of their patients. Future dentists should be providers of primary care, yet data suggest that the organizational structure to support this vision is lacking. The accreditation system, interrelated with licensure and National Boards, needs to set a better floor. While independence is an admirable goal, I see too much variation in the accreditation system. We must overcome fears and politics to upgrade the profession as pharmacy did when it introduced the Pharm.D. degree. With that came a change in the entire system of pharmacy education and clinical practice and recognition of pharmacists as members of an interdisciplinary health care team. Dentistry and dental education are doing a lot that is good, but we must and can do even better if the profession is to thrive as a respected member of the health professions delivering high-quality, evidence-based care to the public. Dental students, faculty, and practitioners must have command of new and coming scientific advances and technologies that will have a profound impact on the practice of dentistry. We must take the long view in educating our students so they will, as practitioners, be able to expertly evaluate and use new technologies throughout their careers. With regard to technologies, three examples may help clarify their future importance in dentistry: 1) oral fluids and tissues are natural tools for health surveillance; 2) within the next five to ten years, microarrays of all 700 bacterial species will be available for diagnostic purposes as will treatment tied to this diagnostic tool; and 3) biomarkers of inflammation will continue to develop into chair-side technologies with appropriate treatments. These three examples-along with spectacular advances in imaging, materials science, stem cell biology, and regenerative medicine-signal the need for rigorous change in dental education and practice. If we desire twenty-first century clinicians, we are obligated to teach students to "learn how to learn." We must teach them to practice evidence-based dental medicine. We must teach them to operate as members of interdisciplinary, primary health care teams. Moreover, we must ensure that the face of the profession-its practitioners-reflects the rich diversity of the community. Attendees at the Macy convocation are in a position to provide leadership, to work with appropriate organizations, and to enable Pharm.D.-like consensus. It behooves us to agree on a unified vision for revitalizing dental education. The vision should be based on a set of principles, either those originally laid out by W.J. Gies in 1926 or ones that may be a better fit with this day and age. The following are several recommendations for transformative change in dental education. In my view, based on my experience as a dental professional and leader, and by looking beyond our educational boundaries to places like MIT, I believe that they may be the most promising: 1) think BIG!; 2) involve students in hands-on learning experiences from day one; and 3) provide students and the profession with the tools to tackle major biomedical, clinical care, and societal issues including access to care, cost of care, HIV, emerging infectious diseases, elder care, and many others. In fact, I believe that we already know what to do to upgrade the dental profession. We need to make it happen. We need to act as catalysts for change. We understand that change is necessary but continue to struggle with implementing sustained curriculum reform and regulatory reform. Why? Partly because we have not convinced the dental profession and the education community that a crisis really exists. "Crisis" may sound to the uninformed like crying wolf, especially in a climate in which dentists in private practice are doing exceedingly well. Further, we have not provided a compelling vision for the future. Transformation will require a profound reexamination of what we are doing today and what is necessary for survival and sustained growth. We must keep pace with new knowledge and methods of teaching-unless, of course, we choose to subscribe to the facetious message of W. Edwards Deming, who is credited with rebuilding the Japanese economy after World War II: "It is not necessary to change. Survival is not mandatory."