Advanced Education In General Dentistry Research Articles

A Competency‐Based Framework for Training in Advanced Dental Education: Experience in a Community‐Based Dental Partnership Program

While goals and objectives are useful to assess programmatic outcomes, they are not able to evaluate individual trainees' performance and/or corrective actions needed to improve performance. As a result, competency-based evaluation is increasingly being used to assess trainee performance at both the doctoral and postdoctoral levels. However, the translation of broadly stated competency statements into evaluable action statements continues to pose a challenge, especially in nontechnical domains such as the assessment and integration of cultural and sociodemographic variables in the development and execution of treatment plans. This article describes a process used to develop a competency-based framework that includes specific evaluable action statements to assess the performance of Advanced Education in General Dentistry (AEGD) residents providing dental care services to medically compromised patients in a community-based partnership program. Although the resultant framework may not itself be generalizable across training programs, the process described to develop the framework can be used by those individuals involved in evaluating students and/or residents in training programs.

Considering Theory‐Based Reflection in the Service‐Learning Training of Advanced Education in General Dentistry (AEGD) Residents

Columbia University College of Dental Medicine, in partnership with the Harlem United Community AIDS Center, has developed a service-learning (SL) program for use in the training of Advanced Education in General Dentistry (AEGD) residents. This article presents basic tenets of SL, their applicability for dentistry, and our experience implementing SL in care of people living with HIV/AIDS. It proposes that social-behavioral theory, when incorporated into the basic components of SL, can play a useful role in resolving a number of challenges inherent in competency-based training programs. Although the article provides examples of how a particular theory, the Theory of Planned Behavior, might be applied in the SL context, opportunities for the application of other social-behavioral theories potentially exist.

The Impact of Title VII on General and Pediatric Dental Education and Training

The authors describe the impact of the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program on the development, growth, and expansion of general and pediatric dentistry residency programs in the United States. They first briefly review the legislative history of the Title VII program as it pertains to dental education, followed by a historical overview of dental education in the United States, including a description of the differences between dental and medical education and the routes to professional practice. The authors then present an extensive assessment of the role of the Title VII grant program in building general and pediatric dental training capacity, diversifying the dental workforce, providing outreach and service to underserved and vulnerable populations, stimulating innovations in dental education, and engaging collaborative and interdisciplinary training with medicine. Finally, the authors call for broadening the scope of the Title VII program to allow for predoctoral training (dental student education) and faculty development in general and pediatric dentistry. In doing so, the Title VII program can more effectively address current and future challenges in dental education, dentist workforce, and disparities in oral health and access to care.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Advanced General Dentistry Program Directors’ Attitudes and Behaviors Regarding Pediatric Dental Training for Residents

The oral health of children became a more prominent concern with the U.S. surgeon general's report on oral health in America in 2000. The purpose of our study was 1) to assess General Practice Residency (GPR) and Advanced Education in General Dentistry (AEGD) (here jointly referred to as advanced general dentistry [AGD] programs) directors' current behaviors with regard to pediatric training of residents and 2) to assess their attitudes about which components of pediatric oral health training should be included in AGD programs. A twenty-one item survey was mailed to all GPR and AEGD programs accessed through the American Dental Association website. Seventy percent of directors (N=187) completed and returned the survey. Responses indicated that AGD residents receive adequate clinical exposure to pediatric patients and provide much-needed services to uninsured, underinsured, and underserved people. Although clinical training in pediatric treatment was high, didactic hours focused on pediatric treatment did not seem commensurate with clinical activity. Program directors indicated strong attitudinal support for teaching residents many components of pediatric oral health care, although most directors have concerns over increasing didactic hours spent on pediatric oral health due to already crowded curricula. Approximately 88 percent of directors said that they would implement a pediatric oral health module in their curricula if they had access to one.

ADEA Survey of Clinic Fees and Revenue: 2003–04 Academic Year

The American Dental Education Association's 2003-04 Survey of Clinic Fees and Revenue obtained data by which to report, by school, clinic revenue information per student. Fifty-one of the fifty-four dental schools that had third- and fourth-year students responded to the survey. The median revenue per third-year student was dollar 9,937. It was dollar 13,602 for fourth-year students. Clinic revenue was also obtained for programs of advanced dental education. General Practice Residency programs generated the highest revenue per student at dollar 66,474, followed by programs of Advanced Education in General Dentistry at dollar 63,860. Other areas of the survey provided information regarding clinic fees by type of program, levels of uncompensated care by type of program, clinic revenue by source of payment, and dental school fees as a percent of usual and customary private practice fees.

Gender Differences in Career and Practice Patterns of PGD‐Trained Dentists

This study compares differences by gender in the practice patterns and professional activities of general dentists, specialists, and dentists with Advanced Education in General Dentistry (AEGD) or General Practice Residency (GPR) training. The UCLA School of Dentistry surveyed a random sample of 6,725 dentists graduating from dental school in 1989, 1993, and 1997 as part of an evaluation of the impact of federal funding on postgraduate general dentist (PGD) programs. The survey asked about current practice, services referred and provided, and professional activities. Of the 2,029 dentists (30 percent) who responded, 49 percent were general dentists with no specialty training; 7 percent had AEGD training; 20 percent had GPR training; and 24 percent had specialty training. General dentists were more likely to be in private practice (p < 0.05). AEGDs, specialists, and females were more likely to report faculty positions as a secondary occupation. General dentists were more likely to be practice owners than AEGD- or GPR-trained dentists. The mean number of patients seen was highest for specialists. Females reported fewer patients than males, and this difference was significant for GPR-trained dentists. With respect to services, GPR-trained dentists reported significantly more biopsy procedures, conscious sedation, periodontal surgery, and implants than general dentists. AEGD-trained dentists reported more conscious sedation than general dentists. GPR dentists were more likely to volunteer time than general dentists without specialty training. PGD training appears to result in different types of employment and specific practice patterns that strengthen primary care dentistry. We further conclude that there are gender differences in the types of practice, patients seen, and services provided. These findings occur in addition to training differences.

PGD Training and Its Impact on General Dentist Practice Patterns

This study compares the practice patterns of general dentists with and without formal advanced training in AGED or GPR programs. The UCLA School of Dentistry surveyed a random selection of dentists from graduating years 1989, 1993, and 1997 as part of a Health Resources Services Administration (HRSA)-supported evaluation of the impact of federal funding on postgraduate general dentistry (PGD) programs. Using a sample drawn by the American Dental Association (ADA), 6,725 dentists were surveyed about their practice, advanced training, patients served, and services provided. Of the 2,029 dentists (30 percent) who responded, 49 percent were practicing dentists with no formal advanced training in general dentistry or one of the eight ADA specialties; 7 percent had Advanced Education in General Dentistry (AEGD) experience; 20 percent trained in a General Practice Residency (GPR); and 24 percent were specialists. Additionally, 7 percent of respondents had PGD training and a clinical specialty. GPR-trained dentists were significantly more likely to be on a hospital staff and to treat medically compromised patients even after ten years of practice. PGD dentists were less likely to seek specialty training. Major reasons for seeking PGD training were increasing treatment speed, learning to treat medically compromised patients, and wanting hospital experience. Primary reasons for not selecting training were starting a practice and having a great practice opportunity. Our conclusion is that PGD training has an enduring impact on practice patterns and improves access to dental care for underserved populations.

Stippling complete dentures with a nonconcentric bur

J Prosthet Dent 2002;88:109-10.

Characteristics of Civilian Postdoctoral General Dentistry Programs

U.S. civilian (non-VA/non-military) Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs were identified (n=208) and surveyed. The assessment evaluated infrastructure support, populations served, services provided, and trainee stipends. One hundred thirty-one programs responded (thirty-two AEGD, 64 percent/ninety-nine GPR, 63 percent). Sixty-nine programs were HRSA-funded (53 percent), and sixty-three (47 percent) were nonfunded. One hundred and five responses identified hospital/medical center resources; fifty-six indicated dental school support. Mean faculty support was similar regardless of program type or HRSA funding. Mean first-year positions in AEGDs were greater than GPRs. Mean first-year GPR positions were greater in funded than in nonfunded programs. A comparison of AEGD and GPR programs showed that residents in GPRs treated more children, medically intensive, economically/socially disadvantaged, and in-patient/same-day surgery patients (p<0.05). Residents in AEGDs treated more healthy adults (p<0.05). GPRs treated more lower fee (no pay, Medicaid, welfare/general relief, Medicare, and capitation/HMO) patients. AEGDs treated more insurance/private pay patients (p=.0001). No differences existed in comprehensive care and emergency visits between AEGDs and GPRs. GPRs treated more hospital-based patients. The mean stipends for GPRs ($32,055) and AEGDs ($22,403) were different.

Perceived Initial Clinical Competencies of Dentists at the Start and Completion of U.S. Air Force Advanced Education in General Dentistry Residency Programs

The purpose of this study was to determine whether there was a difference in the perceived level of competence in recent dental school graduates before or after completion of a 1-year general dentistry residency program. A survey instrument was administered to recent dental school graduates before or after completing a 1-year U.S. Air Force Advanced Education in General Dentistry (AEGD) residency program to evaluate their self-perceived competency in 60 selected diagnostic and clinical areas at the time of their graduation from dental school. Questionnaires were returned by 103 test subjects, for a response rate of 92%. Pearson's chi 2 test revealed a significant difference in self-perceived competence at the time of graduation from dental school between dentists just completing dental school and dentists who had just completed a 1-year postgraduate AEGD residency. Dentists completing a 1-year postgraduate general dentistry residency perceived themselves to be statistically less competent at the time of dental school graduation than dentists who had just completed dental school in 9 of 60 areas. A significant difference exists in the opinions of new dental school graduates compared with dentists with an additional year of training regarding their level of competence at the time of dental school graduation.

EMERGENCY CARDIAC CARE: Moral, Legal, and Ethical Considerations

According to the American Heart Association “Successful completion of an ACLS course means in accordance with the cognitive and performance standards of the American Heart Association. It does not warrant performance, nor does it, per se, qualify or authorize a person to perform any procedure. It is in no way related to licensure, which is a function of the appropriate legislative, health or educational authority.” 11 The same can be said for BLS; however, with the recent revisions in ECC programs, even this disclaimer has been eliminated from the most recent textbooks in BLS and ACLS. This is in keeping with “… the American Heart Association's reaffirmation of its role as an educational resource rather than as a certifying agency.” 21 Lay public course participants in BLS (which technically includes dentists) will now receive course participation cards. Health care provider course participants will continue to receive “course completion cards” if all criteria have been satisfied by the student. The trend is to categorize what was previously termed testing as evaluation. Certification has become a thing of the past. It is unclear at this time what the impact this policy change will have on agencies who rely upon documentation from the American Heart Association to satisfy requirements that have been imposed upon dentists and other health professionals for initial licensure and relicensure. Semantics aside, one thing that remains clear is the expectation of the dentist with regards to emergency management. Expertise (for lack of a better term) in specific aspects of ECC remains a standard. For all dentists, expertise in BLS is that standard. For dentists administering deep sedation and general anesthesia, expertise in ACLS is the community standard. Although there is some ambiguity for those dentists administering conscious sedation, at the very least, they should have expertise in BLS. In addition, they are strongly encouraged to have expertise in ACLS, particularly because the limited hours of training in conscious sedation provide less medical background than is acquired during training in deep sedation and general anesthesia. In addition, the dentist is ultimately responsible for the demeanor of his or her office and staff. In the prehospital dental office setting, the matter of converting a dental office team geared to efficient delivery of dental procedures, into a team primed to perform emergency cardiac care seems daunting. This is especially so if the dentist has little undergraduate or clinical preparation for managing life-threatening emergencies. Therefore, an emergency management plan (with oversight for its implementation by the dentist) is of paramount importance. Although not mandatory, BLS training for the entire office staff is an excellent place to begin the process of building teamwork towards management of the emergency situation. Dentists are highly trained to provide a manually demanding service. We hold ourselves to a high standard. Our daily practice is highly focused on successfully avoiding untoward sequelae. Dentists can be highly critical of others and often themselves if they fail to avoid usual dental complications. However, the concept of managing a cardiac arrest as an untoward sequelae of dental care is at a completely different level. Undergraduate dental education does not provide clinical preparation for dentists to manage life-threatening emergencies beyond training in BLS. Advanced education in general dentistry (AEGD) programs or general practice residency programs provide little or no clinical or didactic training beyond BLS in cardiopulmonary resuscitation. Dental residents during oral and maxillofacial surgery, pediatric dental, or dental anesthesiology training programs get exposure to medical emergencies on rotation with various medical services. As the years pass in private practice, emergency medical skills that are infrequently applied wither from disuse. 16 Responsibility to deal effectively with a medical emergency must remain constant and can never be allowed to lapse.

The growth of postdoctoral general dentistry programs.

From 1972 to 1990, the number of Postdoctoral General Dentistry (PGD) programs increased by 57% and enrollment increased by 57% and enrollment increased by 131% for a total of 118 PGD programs and 1,367 positions. Although there has been some increase in military and Veterans Affairs (VA) programs, the major increase was in civilian programs. From 1972-78, the major impetus for growth was hospital sponsorship of General Practice Residency (GPR) programs. With federal funding of PGD programs, civilian GPR programs continued to be the main source of growth until the accreditation of Advanced Education in General Dentistry (AEGD) programs in 1981. Subsequently, almost all increases were in AEGD programs. Over the 12-year period of federal funding (1978-90), there was an increase of 406 civilian PGD positions to make a total of 925 positions. The increase in enrollment directly attributable to federal funding was 242. The "unmet demand" for PGD programs was estimated to be approximately 300 positions for 1990, from data derived from the Survey of Dental Seniors and the Matching Program. Assuming that the number of PGD positions continues to increase by 35 positions a year, as it has in the past 12 years, the unmet demand would be met in slightly less than 10 years. If, however, a postdoctoral year was mandated for licensure, the increase in the number of positions would be far short of projected need.

The program directors' perspective on the goals and objectives of advanced general dentistry training

In September of 1991, all postgraduate general dentistry (PGD) program directors (Advanced Education in General Dentistry [AEGD] and General Practice Residency [GPR] directors [n = 325]) were surveyed to ascertain their opinions of the ideal goals and objectives of PGD programs. The response rate was 81.5 percent (n = 265). The directors rated the relative importance of various PGD program goals and objectives. The average of all the items rated was 3.4 on a scale ranging from 1 = unimportant to 4 = very important. The respondents identified several clinical and didactic subject areas that they considered very important including; infection control, CPR, dental and medical emergencies, diagnosing dentoalveolar trauma, diagnosing oral pathology, and assessment and treatment of patients with medical conditions. They also identified several training areas which were beyond the scope of a PGD program, e.g., research techniques, pediatric sedation, and selected advanced clinical procedures in dentistry (implantology and orthodontics) which require a long time to complete. In general, there was substantial agreement among the directors of different program types and sites as to the relative importance of various program goals. The largest differences were found among directors of programs from different sites, e.g., hospitals versus dental schools as opposed to directors from different program types, e.g., GPR versus AEGD. There is now a need to determine the relationship of these identified idealized goals and differences to program outcomes for the graduates of PGDs.

Advanced education in general dentistry.

Editor's note: This paper was presented at the Southeast Regional Conference of the American Association of Hospital Dentists on April 21, 1979. Even though the newer form of advanced general dentistry programming was approved by the Council on Dental Education, the editor believes that the detailed argumentation in this paper should be published to provide future readers with the documentation and logic behind this newer form of advanced general dentistry education.