Commission On Dental Accreditation Research Articles

A service-learning framework to address accreditation standards: Self-Assessment, communication skills, health literacy, and cultural competence.

Pre-doctoral dental programs must provide opportunities for students to become proficient in self-assessment, communication skills, health literacy, and cultural competence, essential for independent unsupervised practice. This study aimed to assess how student learning through a classroom education service-learning program addresses the Commission on Dental Accreditation (CODA) standards 2-11 and 2-17; specifically through the examination of self-assessment, communication skills, health literacy, and cultural competence. This 2022 retrospective mixed methods cohort study examined unstructured faculty comments on drafted lesson plans and structured evaluations of classroom education service-learning rehearsal sessions. A random sample of faculty comments from three academic years, 2018, 2019, and 2020, were deidentified and analyzed by five researchers for emerging themes using NVivo. Quantitative data from rehearsal presentations were analyzed with descriptive statistics to assess the concordance of self and faculty feedback on specific evaluation criteria. Six major themes from faculty lesson plan feedback emerged: knowledge, professionalism, communication, presentation skills, cultural competence, and program logistics. Concordance between faculty feedback and student self-assessment ranged from 83% to 92.4% across all evaluation criteria over the 3 years: spoke clearly and confidently at the right pace, provided accurate dental terminology and facts, used grade-appropriate language, provided clear instructions to follow, appeared enthusiastic throughout the rehearsal presentation, and designed a well thought out lesson plan that will engage children for the entire presentation. Findings support the classroom education service-learning program as a framework to provide opportunities for student self-assessment and feedback on communication skills, health literacy, and cultural competence aligned with CODA standards 2-11 and 2-17.

Assessment of advanced paediatric dentistry education programmes in Egypt: a survey of programme directors.

Advanced paediatric dentistry education programmes (APDEPs) should follow specific standards to produce competent specialists. The current study assessed APDEPs in Egypt via an online questionnaire to programme directors. An online questionnaire was distributed to the directors of fully operational degree-granting APDEPs in Egypt in June 2023. The survey instrument was based on the Accreditation Standards for Advanced Dental Education Programmes in Paediatric Dentistry developed by the Commission on Dental Accreditation (CODA). Directors of the sixteen fully operational APDEPs answered the questionnaire giving a 100% response rate. APDEPs, in Egypt, varied regarding the adequacy of teaching staff, facilities and resources, didactic instruction, clinical requirements, and research activities. The current survey provides information about the strengths and weaknesses of fully operational degree-granting APDEPs in Egypt. This information can help maintain and improve the quality of these programmes.

Training future leaders: A qualitative study exploring leadership development in predoctoral dental curricula.

Commission on Dental Accreditation (CODA) accreditation standard 2-19 states predoctoral dental schools must assess students' ability to function successfully as the leader of the oral health care team. This study aimed to explore how dental schools incorporate leadership training into their curriculum to better understand the leadership skills students learn, the ways students engage in leadership training, and the opportunities students have to practice leadership skills with their peers. The aim of this 2022 qualitative phenomenology study was to use semi-structured interviews with academic Deans at CODA-accredited dental schools and one subject matter expert to uncover types of cognitive, behavioral, and environmental factors influencing leadership training through the lens of social cognitive theory. All interviews were recorded on Zoom, transcribed, de-identified, and analyzed for recurring themes using NVivo. Eight academic Deans and one subject matter expert participated in the study. Four major themes emerged from the data: leadership is essential for dental professionals, leadership is incorporated into the curricula in diverse ways, students most often engage in leadership training opportunities with dental peers and interprofessional opportunities could be expanded, and dental schools often face barriers to incorporating leadership training. Vertically integrated case presentations and team-based practice management simulations are meaningful leadership development activities. Prominent barriers include time constraints, lack of faculty champions with teaching leadership expertise, and prioritizing the development of hand skills. Standard practices for student leadership development and assessment do not appear to exist across dental school curricula. Findings support the need for a leadership development framework.

CODA standard 2-24h-"replacement of teeth" dilemma: Unintended consequences and proposed solutions.

The Commission on Dental Accreditation (CODA) was established in 1975 with the goal of serving the public and the dental profession by developing and implementing standards that guide and maintain the quality of dental educational programs. These standards are defined broadly around competencies reflective of an evidence-based definition of general dentistry and that should be met by the new graduates to function as an entry level provider. Consequently, CODA "expects each school to develop specific competency definitions and assessment methods in the context of the broad scope of general dental practice". CODA Standard 2-24h was implemented a decade ago to address concerns that dental schools are not sufficiently proactive in incorporating implant-related curricula and clinical competencies. When the standard was implemented, most patients already preferred dental implants over FPDs. This market trend, together with the prescriptive format of the standard, had the unintended consequence of creating pressure on programs that struggled to find enough patients who will chose FPDs as a treatment option. As a short term solution, we suggest a tooth replacement competency construct that has the potential to alleviate this burden. This solution incorporates principles of ethical decision making, patient-centered care, and evidence-based dentistry, without compromising educational aspects and competency development. For the longer term, we suggested to revise and rephrase the standard so that it will be clinically-centered rather than focused on technical tools that may evolve, change, or disappear as a result of technological progress and other market trends. This, in turn, will be conducive to fulfill the intent of Standard 2-24 to allow the schools to identify "competencies that will be included in the curriculum based on the school's goals, resources, accepted general practitioner responsibilities and other influencing factors."

A Snapshot on Oral and Maxillofacial Surgery Resident Scholarly Activity: Can We Do Better?

The Commission on Dental Accreditation (CODA) requires oral and maxillofacial surgery (OMS) residents to engage in scholarly activity. Currently, it is unknown how this mandate translates into research output. The purpose of this study was to quantify the research output of OMS residents. In addition, we sought to identify characteristics associated with resident productivity. This was a cross-sectional study of all OMS residents during the 2021-2022 academic year. Attempts were made to obtain resident rosters from every CODA-accredited OMS program. Resident names were searched in PubMed (https://pubmed.ncbi.nlm.nih.gov/) to identify peer-reviewed publications. Postgraduate year (PGY), program name, and total publication count during residency were recorded for each resident. Academic status and fellowship affiliation of the residency program were also included. The primary predictor was PGY level of each resident. The main outcome variable was the publication count of each OMS resident during the 2021-2022 academic year. The covariates were the academic status and the fellowship affiliation of the residency program. A program was determined academic if they were associated with a dental or medical school. Aprogram was determined fellowship associated if they had any CODA approved fellowship. Simple bivariate comparisons were performed using Wilcoxon signed-rank tests. Complete resident rosters were identified for 87 residency programs. One thousand one hundred thirty two residents were queried and a total of 548 peer-reviewed publications were identified. There was a mean of 6.30 publications per program and 0.43 publications per resident. More than half of all residents had no identifiable publication. PGY5 residents averaged the most publications per resident (1.45) followed by PGY6 (1.04) and PGY4 (0.63). Academic programs had significantly more publications per resident than nonacademic programs (median of 3.00 vs 0.00, P=.02). Programs with a fellowship association also had more publications per resident (median of 5.00 vs 2.00, P<.01). Current CODA research requirements do not translate into resident publications. Publication counts appeared to slightly increase with PGY level; however, OMS resident productivity still lags far behind that of other surgical subspecialties.

Establishing an antiracism framework for dental education through critical assessment of accreditation standards.

The purpose of this manuscript is to establish an antiracism framework for dental education. Since the accreditation process is an influential driver of institutional culture and policy in dental education, the focus of the framework is the Commission on Dental Accreditation (CODA) standards for predoctoral education. The authors of this manuscript reviewed each CODA predoctoral standard for opportunities to incorporate antiracism strategies. Eight standards were identified under themes of diversity (Standards 1-3, 1-4, 4-4), curriculum development (Standards 2-17, 2-26), and faculty recruitment and promotion (Standards 3-1, 3-4, 3-5). Guided primarily by National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, a logic model approach was used to critically assess those standards for opportunities to establish antiracism strategies, with anticipated outcomes and impacts. Strategies highlighted a need to improve recruitment, admissions, and accountability among dental schools to address the low numbers of historically underrepresented racial and ethnic (HURE) students and faculty. They emphasized the inclusion of racism in curricula geared toward training dental students to provide care to HURE populations. Finally, there are opportunities to improve accountability that dental schools are providing equitable opportunities for career advancement among HURE faculty, with consideration of conflicting demands for scholarship with HURE student mentoring, role modeling, teaching, and/or service. The framework identifies gaps in CODA standards where racism may be allowed to fester, provides specific antiracism strategies to strengthen antiracism through the accreditation process, and offers dental education programs, a process for evaluating and establishing their own antiracism strategies.

Predoctoral Curriculum Modifications in Caring for Patients With Special Health Care Needs

Recent changes to educational competency standards have been implemented by the Commission on Dental Accreditation (CODA) in preparing dental students to care for patients with special health care needs. A major emphasis includes those patients with intellectual and developmental disabilities. This article offers some broad suggestions to consider when implementing curriculum changes in dental schools.

ORAL MEDICINE EDUCATION IN PRE-DOCTORAL PROGRAMS IN U.S. DENTAL SCHOOLS

<h3>Objectives</h3> The aim of this study was to investigate the current standing of the oral medicine (OM) curriculum in the predoctoral dental programs in the United States and its relation to the students' perceptions of OM as a postgraduate specialty program option. <h3>Study Design</h3> A cross-sectional anonymous electronic survey was distributed by email to the academic deans of all Commission on Dental Accreditation (CODA)-accredited dental schools in the United States. The survey consisted of 2 parts: (1) Part A was completed by the fourth-year dental students and (2) Part B was completed by the academic deans or faculty members serving in a similar role. Descriptive statistics were used to summarize the responses using JMP 15.0 (SAS Institute Inc., Cary, NC). <h3>Results</h3> A total of 4 rounds of surveys were sent between November 2020 and January 2021. The response rate from the associate deans was 28.4% (n = 19). The mean number of American Board of Oral Medicine–certified specialists involved in teaching OM in each dental school was 1.6 (range, 0-5). OM specialists were involved in teaching OM courses in 74% of the schools in addition to other specialists, including oral pathologists (n = 11), oral radiologists (n = 2), oral surgeons (n = 2), and 1 orofacial pain specialist. Oral pathologists alone or with oral surgeons were responsible for teaching the oral medicine courses in 21% and 5% of the schools, respectively. A total of 224 dental students responded to the survey. Most students (n = 114; 51%) reported their first introduction to OM was during their second year of dental school, 39% (n = 87) during their first year, and 8% (n = 17) during their third year. Sixty-four percent of the students thought the OM specialty was not known, 12% thought it was very poorly known, and only 13% thought the specialty was known. Only 1% of the respondents expressed interest in pursuing OM as a future postgraduate specialty choice. <h3>Conclusions</h3> Although OM specialists were involved in teaching OM in the majority of dental schools, students' perceptions and understanding of the specialty appeared to be low. Additional efforts are required to increase students' awareness around OM to better serve the important needs of our patient population.

To What Extent is Each Area of Oral-Maxillofacial Surgery Practiced in the United States Today?

To What Extent is Each Area of Oral-Maxillofacial Surgery Practiced in the United States Today?

Racial and oral health equity in dental school curricula.

ObjectivesThe objective of this study was to assess the current efforts to move dental school curriculum beyond diversity and inclusion toward an anti‐racism approach to racial equity.MethodsIn this cross‐sectional study, an electronic Qualtrics survey was sent to 67 Dental School Associate Deans/Deans of Academic Affairs and 15 Dental Public Health (DPH) Residency Program Directors. Survey topics included oral health equity, Critical Race Theory (CRT), racism and the physiologic impacts of racism on oral health. Descriptive statistics were used to demonstrate frequencies.ResultsOverall response rate was 31.7% (DPH = 6, predoctoral Dental = 20). The majority of respondents that answered the question stated that the educational program offered instruction in oral health equity (96.2%), racism (75%), and the physiologic impacts of racism on oral health (83.3%). Only 17.4% of the respondents stated that the educational program offered instruction in CRT. The main barriers to providing the instruction was limited faculty trained in the topics to offer the instruction or there was limited time to offer additional content in the curriculum.ConclusionsFindings demonstrate that oral health equity, racism and the physiologic impacts of racism are being discussed in dental education to some extent, but there is limited instruction in CRT. More robust efforts are needed to ensure dental students and DPH residents are competent in providing anti‐racist and unbiased health care; there should be an incorporation of anti‐racism standards in the Commission on Dental Accreditation (CODA)'s predoctoral and Advanced Education Program standards.

Oral medicine education in predoctoral programs in US dental schools.

the purpose of the study was to explore the structure of oral medicine (OM) education in predoctoral dental programs in the United States and to evaluate the students' perception of OM as a dental specialty. Two anonymous Qualtrics surveys (Qualtrics, Provo, UT, USA) were distributed electronically to the academic deans of all the Commission on Dental Accreditation (CODA) accredited dental schools in the United States. Upon completing the survey, the academic deans were asked to forward the student surveys to their students. Note that 26.8% (18/67 dental schools) of academic deans that participated in the survey, 224 senior students responded to the student survey. The results showed that the median number of OM specialists involved in teaching OM to predoctoral students was two. Oral cancer screening and diagnosis and management of oral mucosal diseases were identified by the majority of respondents (95.7%; n=214 and 96.5%; n=216), respectively, as part of the scope of practice of OM specialists. Although most students reported Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) (18.67% n=42 each) as postgraduate specialties of interest, students' positive impression in OM increased by a crude average of 0.4 with each additional OM faculty member in the school (p=0.000; 95% CI 0.207-0.594). OM faculty members are in an important position to enhance dental students' perception and interest in OM as a specialty, which would lead to improved awareness of the scope of the specialty and consideration of pursuing specialty training.

Pandemic preparedness in dental education: A US-based national survey.

ObjectivesThe Coronavirus Disease‐19 (COVID‐19) pandemic highlighted the need for pandemic preparedness (PP) in health professions training. We aimed to (1) establish a current profile on curricular content of PP in US dental schools and (2) examine how schools were adapting their curricula in response to COVID‐19.MethodsAn online survey was developed and sent to senior leadership to all 66 Commission on Dental Accreditation (CODA)‐accredited US dental schools including Deans of Academic or Clinical Affairs from November 2020–February 2021. Questions addressed PP curricular content, teaching methods, and evaluation. Participants were asked about the barriers and facilitators for the inclusion of this content. The survey also included questions on redeployment of the clinical workforce in response to the pandemic.ResultsThe response rate was 31.8% (n = 21) with representation from every US Census Bureau‐designated division. While all responding dental schools agreed that dental professionals can play an important role during pandemics, 38.1% reported including content on PP into their pre‐ or postdoctoral curriculum. In response to the COVID‐19 pandemic, approximately 47.6% indicated redeployment of their clinical workforce to participate in disaster life support, assisting physicians in COVID‐19 cases, and assisting hospitals with personal protective equipment (PPE).ConclusionThere was general agreement that dental professionals can play an important role during pandemics. The participating US dental schools responded to the COVID‐19 pandemic by integrating novel clinical activities. More efforts are required to include PP in dental education.

Dentists as Primary Care Providers: Expert Opinion on Predoctoral Competencies

Dentistry and medicine traditionally practice as separate professions despite sharing goals for optimal patient health. Many US residents experience both poor oral and general health, with difficulty accessing care. More efficient collaboration between these professions could enhance health. The COVID-19 pandemic disclosed further disparities while underscoring concerns that physician supply is inadequate for population needs. Hence, enhancing healthcare provider education to better meet the public's health needs is critical. The proposed titles “Oral Physician” or “Oral Health Primary Care Provider” (OP-PCP) acknowledge dentist's capacity to diagnose and manage diseases of the orofacial complex and provide some basic primary healthcare. The US Surgeon General's National Prevention Council and others recommend such models. Medical and dental education already overlap considerably, thus it is plausible that dental graduates could be trained as OP-PCPs to provide primary healthcare such as basic screening and preventive services within existing dental education standards. In 2018, 23 dental and medical educators participated in an expert-opinion elicitation process to review educational competencies for this model. They demonstrated consensus on educational expansion and agreed that the proposed OP-PCP model could work within existing US Commission on Dental Accreditation (CODA) standards for predoctoral education. However, there were broader opinions on scope of practice details. Existing CODA standards could allow interested dental programs to educate OP-PCPs as a highly-skilled workforce assisting with care of medically-complex patients and to helping to reduce health disparities. Next steps include broader stakeholder discussion of OC-PCP competencies and applied studies including patient outcome assessments.

Is There a Single Solution for the Dual-Degree Dilemma?

Although the oral and maxillofacial surgery (OMS) residency is accredited by the Commission on Dental Accreditation (CODA), dual-degree surgeons often practice under the auspices of both Doctor of Dental Surgery/Doctor of Dental Medicine and doctor of medicine (MD) licensures and therefore face additional requirements to receive and maintain their credentialing. For some time, every state accepted 1 year of recognized postgraduate Accreditation Council for Graduate Medical Education (ACGME) training to meet medical licensure requirements.

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

Offerings for Foreign-Trained Dentists pursuing unrestricted licensure in the United States

Background:While about 50% of applicants are accepted into dental schools, acceptance rates to Internationally Trained Dentist Programmes(ITDPs) are estimated to be about 2% making it one of the most competitive dental programmes in the United States. Aim:This paper provides a structured review of dental school websites in order to document and distinguish training opportunities for foreign trained dentists that do and do not lead to unrestricted licensure in the United States (U.S.) Materials and Methods: Three independent reviewers conducted a manual search of the US dental school website and a fourth served as arbiter. University of Michigan Medical School’s Committee on Human Research reviewed the study and deemed that no IRB oversight was necessary for this review. Results: Only 40 US dental schools offered Internationally Trained Dentist Programmes (ITDPs) for foreign trained dentists. Additionally, there were 32 non-clinical, non- Commission on Dental Accreditation (CODA) accredited programmes that do not lead to licensure. Conclusions: Our study found that less than 60% of dental schools offer an offered Internationally Trained Dentist Programme (ITDP) but several offer observerships/externships to foreign trained dentists that do not lead to licensure. Both of these programmes are costly and timely, therefore, schools with these programmes; observerships/externships should consider expanding the number of seats in their Internationally Trained Dentist Programme (ITDPs) or if they do not have an Internationally Trained Dentist Programme (ITDP) but offer an observerships/externship programme, then possibly creating one. KeyWords: Academic recruitment; Professional student; Licensure and certification.

Curricular and clinical approaches to addressing the opioid epidemic: Results from the 2019 ADEA opioid dental school survey

Dental educators have played a critical role in addressing the opioid public health crisis. The American Dental Education Association (ADEA) conducted a semi-structured survey with all 66 accredited U.S. dental schools in 2019. The survey was organized into four modules to facilitate response and descriptive statistics and qualitative thematic analyses were performed. Seventy percent of the dental schools consented to participate. Each module varied in response rate: curricular (Module 1, 48%), clinical (Module 2, 47%), implemented curricular/clinical changes (Module 3, 56%), and willingness to participate in future studies (Module 4, 47%). The survey revealed that 87% of respondent dental schools have implemented curricular changes or curricular changes were in process in response to the opioid epidemic. Ninety-three percent of responding schools reported making clinical changes or that clinical changes were in process. Schools reported two factors that most frequently influence changes made: the adoption of state-specific regulations/mandates and the Commission on Dental Accreditation (CODA) Standard 2-24e, which requires competency in prescription practices on substance use disorders. An analysis of the open-ended questions found four overarching themes to curricular changes, in order of frequency: didactic curriculum; integration of opioid epidemic subject matter experts in curricula; Screening, Brief, Intervention, and Referral to Treatment (SBIRT) training; and prescription guidelines. Similarly, four overarching themes were identified for clinical changes: protocol and policy development, Prescription Drug Monitoring Programs (PDMP), faculty and provider education, and prescription guidelines. This research shows that dental educators are working to ensure that new dental professionals gain the necessary competencies in substance abuse, specifically related to opioids, to prevent and minimize prescription drug misuse.

Outcomes from the Health Resources and Services Administration's Dental Faculty Development Program.

While the Commission on Dental Accreditation (CODA) requires programs to conduct faculty development, implementation of faculty development activities vary widely. Faculty development programs can enhance teaching, research, and leadership skills needed to transition from clinical practice to teaching. In 2012, the Health Resources and Services Administration (HRSA) funded 6 institutions to plan, develop, and operate programs for training oral healthcare providers who plan to teach in general, pediatric, public health dentistry, or dental hygiene. This performance study examines the results of the dental faculty development programs. After the 5-year grant program (2012-2017), we used descriptive analysis to examine annual performance data including trainee demographics, faculty development activities, post-completion intentions, and course development activities. Nearly 300 trainees participated across 6 funded grantees; the majority were female, aged 30-49 years, and non-Hispanic White. For those who completed, 80% intended to teach. Common faculty development activities included community-based training, curriculum enhancements, Web-based training, and interprofessional education methods. Faculty development modalities included faculty seminars, Master's degrees, and mentoring. Pipeline activities, online resources, and continuing education supported dental students and providers moving into academics. Faculty development better prepares individuals to compete in academic environments and develop faculty. Community-based programs may utilize faculty development to recruit community preceptors and achieve calibration. HRSA investment in faculty development programs builds resources and infrastructure to promote continuing engagement in clinical education, research, and administrative skills. Future research is needed to establish the impact of faculty development initiatives on practice change and patient outcomes.

Prosthodontic Resident Selection by Postdoctoral Dental Matching Program: A National Survey by Participating Program Director.

The purpose of this study was to obtain information about the resident selection and Match process that occurred for the Commission on Dental Accreditation (CODA)-accredited Advanced Education in Prosthodontics program in North America from the program directors' perspective, after the first year of implementation. The list of Advanced Education in Prosthodontics program in CODA-accredited North American institutions was obtained from the ACP central office, and the directors of each program were identified. The surveys were distributed to 48 program directors online and results were compiled. Out of 48 programs, 43 directors responded to and completed the survey (90.0%), where 35 programs participated in the Match process, 5 did not, and 3 were omitted due to incomplete surveys. While the majority of programs did not see any changes in their applicant pool or their quality, 10 programs (25.0%) observed a number of increases in the application and 13 programs (32.5%) observed an increase in the quality of the applications. Among the 35 programs that participated in the Match process, the main reasons for their participation were "fairness" (48.2%), "did not want to keep moving up interview dates" (23.2%), and "have applicants come to interview as planned" (21.4%). Thirty-three programs reported that 75% to 100% of the invited applicants came to the interview (76.7%). The majority of programs that participated in Match expressed satisfaction with the process (29/33, 80.6%). Sixteen programs (45.7%) reported that they matched with 100% of their first selections. Overall response of reintroduction of the Match process for advanced prosthodontic resident selection was very positive for majority of the program directors.

Contemporary appraisal of factors influencing pediatric dental program directors' selection of residents.

With the increasing number of applicants and changes to information available in applications, pediatric dentistry program directors must adapt the resident selection process. The evaluation approach was significantly impacted when the National Board Dental Examination (NBDE) changed to a pass/fail grading system. The purposes of this are study to examine what criteria pediatric dentistry program directors now use to select residents, and to evaluate current criteria against those used in the past. A 30-item survey was structured similar to a previous questionnaire used in 2005. An invitation to participate was sent via email to all pediatric dentistry program directors for the 82 Commission on Dental Accreditation (CODA)-accredited programs located in the United States and Canada. Anonymous responses were analyzed. There were 58 responses (70.7% response rate). The overall most important factors were clinical grades, dental school class rank, dental school grade point average (GPA), and applicant's essay. The least important factors were the applicant being a graduate of the program's dental school, Advanced Dental Admission Test (ADAT) score, and applicant's fluency in a second language. The factor that had the most significant increase in importance from 2005 is the applicant's essay, followed by dental school reputation and the dental school's pediatric program reputation. The most important factors to program directors are clinical grades, dental school class rank, dental school GPA, and applicant's essay. The applicant's essay has increased in importance since 2005.