Curriculum Revision for Community-Oriented Dental Education (CODE)

Purpose

Traditional dental education aims to develop technically competent dentists to meet the needs of their patients. Acquainting students with underserved communities and their problems is not a goal of most dental curricula. Typically, after three years of coursework students spend most of their senior year developing clinical skills within the walls of the dental school. Thus, they get neither practical nor even theoretical exposure to community dentistry before graduation and have little notion of career opportunities in underserved communities. It is no wonder that new dentists are ill equipped to respond to the needs of those segments of the population who do not have access to dental care.

In recent years, national reports have called for sweeping changes in dental education, recommending that schools encourage experimentation with new and less expensive forms of education, promote active learning, emphasize community health, and use community-based providers in the training of students.

Self studies and alumni surveys at the New Jersey Dental School confirmed this advice. In response, the school developed the Statewide Network for Community Oral Health Care, which eventually grew to 11 clinics and 23 faculty. The network's clinics in turn provided the venue for CODE, the school's new community-based curriculum.

CODE aims to train dentists who can respond to the needs of the community as well as individual patients. It seeks to produce practitioners who are technically competent in all aspects of general dentistry and to do so in a more time- and cost-efficient manner than the traditional curriculum.

Through their involvement in community projects, CODE students learn to respond to community needs for affordable health care. They become adept at caring for patients as members of a multidisciplinary health team, develop practice management skills, and familiarize themselves with dental career opportunities in public service.

Innovative Features

In order to provide the substantial extramural, community-based experience that CODE demands, the fourth-year curriculum had to be thoroughly revised. A new course on community dentistry and a required community service project were added to the senior-level didactic courses, and the clinical component of the curriculum was redesigned. Because faculty wanted to involve students at all skill levels, they chose each year's group of eight to 12 CODE students from all but the bottom quintile of the senior class.

Three of the clinics in the Statewide Network for Community Oral Health Care, staffed with broadly-trained generalist faculty and supplemented by specialists from the dental school, became CODE's clinical education venues. Each clinic is managed by two faculty members, who also ensure a good mix of patients and monitor student progress. Both instructors teach, care for patients, and engage in professional development activities. Specialist faculty from the dental school make regularly-scheduled visits to the clinics.

The didactic component of the CODE curriculum consists of traditional courses on treatment planning, restorative dentistry, oral surgery, and infection control. The new course, Dentistry in the Community, explores basic concepts in public health, community dentistry, current issues in health and social policy as they apply to dental care and basic skills in the collection and interpretation of population-based data and in designing oral health promotion programs.

All students work on an organized community service project, in collaboration with service agencies near the clinics. Projects have included, among others, health promotion lectures to the elderly or to pregnant teens; oral health assessments for home-bound geriatric patients; a curriculum for Head Start children, teachers and parents, and dental services for the children; and a resource guide on family violence for dental professionals.

CODE students complete the required didactic courses and conferences at the dental school on Mondays, provide care at the clinics for three and a half days a week, and engage in community learning experiences for half a day a week. They meet with the instructor of Dentistry in the Community and with the CODE educational coordinator every two weeks to discuss their progress.

Because dental training is traditionally organized around specialized programs, New Jersey Dental School faculty wanted to ensure that the generalist faculty at the clinics would be able to teach all disciplines. Accordingly, each new instructor participated in 70 half-day training sessions with seven departments of the dental school. The sessions were designed to instruct faculty in the school's specific way of performing dental procedures and in how to implement the competency- and criteria-based grading systems used by the clinical departments. New faculty were also trained in small-group teaching, problem-based learning, and the CODE philosophy of education.

Evaluation and Project Impact

An external evaluator used faculty and student surveys and interviews, examination results, and information from the school's financial and clinical information systems. The evaluator compared matched groups of traditional students to CODE students on their performance on school competency tests, mock boards, national boards, regional licensing examinations, practice management examinations, and patient care efficiency. A comparison of student-faculty and student-staff ratios, student clinical production, patient collections, and clinic income and expenses yielded insight into CODE's cost effectiveness.

Evaluation results show that, over the course of the project, students manifested statistically significant increases in positive feelings toward community service and toward CODE. Faculty attitudes toward community-based learning and toward CODE also improved. In debriefing interviews, students reported that they felt increased confidence and that CODE made for better simulation of private practice, more faculty feedback, and closer faculty-student relations.

Based on departmental competency examinations and mock boards, all CODE students were certified to sit for the North Eastern Regional Boards (NERB), compared to 69 percent and 73 percent of their matched cohorts. There were no significant differences in performance between subjects and controls on board simulations, on the NERB examination, or on practice management mid-terms and finals.

The evaluator documented a significant difference in the clinical productivity and efficiency of CODE students. In the dental school, students are responsible for making and confirming patient appointments and financial arrangements, as well as setting up and cleaning the operatories. There is minimal chair-side assisting, and students must stand in line to obtain supplies from the dispensary. In the CODE clinics, on the other hand, the low faculty-to-student ratio and the availability of dental assistants, receptionists, and other forms of support enables students to treat about 105 patients a year, versus 41 patients treated by matched controls at the dental school. Although the clinical production of CODE students was more than 2.5 times greater than that of their traditional counterparts, because fees at the dental school are higher, CODE students averaged proportionately lower earnings than the controls.

Analysis of CODE's financial impact upon the dental school is not yet complete, but preliminary data suggest that it is possible for a program such as CODE to be revenue-neutral if the community shares in the costs and if an optimal number of operatories is available with an appropriate mix of providers (students, faculty, and staff dentists).

Lessons Learned

To overcome faculty resistance, which developed despite meetings with department chairs and monthly reports to various committees during the period of project design, staff began to implement CODE with a pilot. Ten senior students did a one-month rotation at a community clinic, came back to campus full of enthusiasm for the new approach, and were instrumental in persuading faculty of the merits of CODE.

Project staff also formed a faculty advisory committee, consisting of one representative from each department, to help to implement CODE and to formulate strategies to eliminate barriers. The committee allowed critical faculty to express their concerns and to take the lead in making the changes they believed necessary.

Project Continuation

CODE has been institutionalized and is being financed by patient revenues and by the dental school.

Dissemination and Recognition

CODE has been the subject of national meeting presentations, a newsletter, a videotape, and a number of journal articles. It received glowing reports during the accreditation site visit by the American Dental Association's Commission on Dental Accreditation. The project director received the first Stephen H. Leeper Award for his leadership of this project by the national chapter of Omicron Kappa Upsilon, the dental education equivalent of Phi Beta Kappa.

Available Information

For additional information contact:

Paul Desjardins
or
Robert Saporito
UMDNJ-New Jersey Dental School
110 Bergen Street
Newark, NJ 07103-2400
Telephone: 512-320-1600 or 973-972-4633

[Diablo Valley College] [ Table of Contents ] [Sinte Gleska University]

FIPSE Home