As a dental educator, I am always surprised by how little the public understands about our professional training. When asked what I do for a living, I must decide between defining myself as a dentist or a teacher. Most people have a personal dentist and working knowledge of what that job title entails, but they rarely consider how their dentist became their dentist. The workings of a dental school are a mystery to most of the population, but the experience is etched firmly in the minds of every dentist I know.
Even though I am currently employed by and fiercely loyal to the same institution I attended, my own memories of dental school are conflicted. I made wonderful lifelong friendships and developed a passion for the field that I still feel today. But I also remember the highly competitive and stressful environment, filled with anxiety and, for lack of a better word, fear. Dental school trauma is a rite of passage in the profession, but I do not think an intimidating and unforgiving environment fosters true learning. Frequently potential applicants ask their dentists to advise them on the process. Instead of recounting to our future colleagues the “horrors” we endured as students, maybe we should emphasize what we wished we had learned and ways the student can try to make the most of the opportunity.
Dental school is hard. Very hard. For the Spring 2023 semester alone, our first-year students are enrolled in 29 credit hours. For reference, twelve credit hours per semester qualifies as full-time status for an undergraduate. As I write this today, our students are taking the CDCA licensure exam during the week the rest of the university is on spring break. It is not surprising our students, regardless of their stellar preparation, feel overwhelmed by the workload when they arrive. In addition to the intensive basic science content of courses like gross anatomy, physiology, and craniofacial genetics, they are grappling with picking up a handpiece or finding tiny canal orifices on extracted human teeth for the first time in their lives. For some of these students, the dental preclinical courses and their dependence on the development of hand skills and technique challenge them in a way no other traditional academic course has before. The realization they cannot study their way to better hand skills is profound. They must physically practice those skills repeatedly and that “practice” will be ongoing throughout their career.
After receiving feedback from our graduates indicating Pitt could offer more training in practice management, the administration introduced a four-year practice management curriculum, consisting of 9 courses throughout the four years. My esteemed colleague and Vice-Chair, Dr. Robert Nerone, and I try to introduce our students to the profession and the responsibilities intrinsic to the field, while also teaching about topics like employment contracts and conflict resolution with staff members. We acknowledge how difficult it is for them to meet the curriculum’s academic rigors while also developing a skillset they had no chance to practice before starting their education. Amid all the studying, it is important to remind them why they were so thrilled to get that acceptance letter less than one year before. It is hard to replicate that joy when faced with an onslaught of exams, and no one prepares you for the degree to which your ability to manipulate wax affects your self-esteem in dental school.
As another focal point, we emphasize increasing clinical efficiency to improve both patient and student experiences within the school. This started with an assessment of how patients register for the comprehensive care clinic. You may remember frustrations with patients during your education from people who missed consecutive appointments or had needs exceeding the abilities of a dental student. We decided to implement a screening clinic, physically separated from our comprehensive care clinics, to minimize disruption to the schedule and properly orient new patients to the school. Individuals interested in treatment at the school are scheduled for a complimentary screening assessment and review by students on rotation in that clinic and attending faculty. They view an informative video explaining details about the process and can ask questions. Once they agree to the exam and complete a brief medical/dental history, the student reviews their case and presents the patient to the attending faculty. The faculty speak with the patients about their needs and decide if they are suitable for treatment in the predoctoral clinic or if they would be better suited to a resident in one of our specialty clinics. Not only does this save the patient time and the aggravation of being shuttled from clinic to clinic, but the dental student’s schedule stays available for patients who are more suitable for their skill level.
Patients considered appropriate for treatment modules are distributed across the 12 student teams and assigned to a pair of students (one third-year and one fourth-year) for a more comprehensive exam. We partner all our students into vertical teams (first-, second-, third-, and fourth-year) to provide continuity of treatment for patients when students graduate. The clinical “partnerships” are assigned randomly, and seven or eight partnerships are managed by each Faculty Team Leader. The team leader helps guide the student partnerships through their clinical training and students learn to navigate the complexities of a business partnership with a classmate. The students’ response to this transition has been incredibly positive and the attrition rate for patients following graduation has decreased drastically. We attribute this to increased familiarity with the clinical partner assuring the patient their care will continue seamlessly when their student doctor graduates. Student productivity is tracked via data analytics to assure students get adequate experiences in all disciplines and patient treatment progression is monitored using reporting from our electronic health record.
As I reflect on my career as a general dentist and an academic, I try to view my experiences through the lens of my former instructors. I think as a profession we have been a little too eager to commiserate with our young colleagues about the deficiencies in our dental educational system without acknowledging the inherent difficulty in condensing such a vast amount of didactic content and physical training into four short years. I must admit, it hurts a little when I read commentary from well-meaning dentists hosting online forums opining about the uselessness of dental school training and recommending that students always select the school with the cheapest tuition as the difference between schools is negligible at best. While I fully acknowledge our school, and all schools, have room for improvement, I also know I have a staff of dedicated and talented faculty who are passionate about improving the process and making Pitt Dental Medicine better than the school they attended.
Dental school has always been and will continue to be difficult. The applicants are more competitive than ever before, and we seem to add new curricula all the time. We strive to keep our standards high and produce competent professionals who serve the dental community. We also hope they reflect on their educational experiences with pride in themselves and our school. My favorite aspect of my job might be receiving an email from a former student, especially one who was a bit disgruntled as a dental student, letting me know they finally understand why I pushed them so hard. Educators are extremely hard on students and usually even harder on ourselves. We want our students to be successful as quickly as possible, but ultimately, time proves the best teacher. We can change the narrative of dental education, but it will take time and focused intention to do so. I think it is time to stop congratulating ourselves for surviving our training and figure out how to improve it for future generations. As each class graduates, I hope at least one member considers a career in education. Even more, I hope that some of our more experienced colleagues choose to come back to education and help guide new dentists into this great profession.