Medicare Support for Dental and Podiatry Graduate Medical Education Programs

IMPORTANCE

Oral health care faces ongoing workforce challenges that affect patient access and outcomes. While the Medicare program provides an estimated $14.6 billion annually in graduate medical education (GME) payments to teaching hospitals, including explicit support for dental and podiatry programs, little is known about the level or distribution of this public investment in the oral health and podiatry workforce.

OBJECTIVE

To examine Medicare GME payments to teaching hospitals for dental and podiatry residents from 1998 to 2018, as well as the distribution of federal support among states, territories, and the District of Columbia.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study was conducted using data from 1252 US teaching hospitals. Data were analyzed from May through August 2020.

EXPOSURES

Dental and podiatry residency training.

MAIN OUTCOMES AND MEASURES

Medicare dental and podiatry GME payments were examined.

RESULTS

Among 1252 teaching hospitals, Medicare provided nearly $730 million in dental and podiatry GME payments in 2018. From 1998 to 2018, the number of residents supported more than doubled, increasing from 2340 residents to 4856 residents, for a 2.1-fold increase, while Medicare payments for dental and podiatry GME increased from $279 950 531 to $729 277 090, for a 2.6-fold increase. In 2018, an estimated 3504 of 4856 supported positions (72.2%) were dental. Medicare GME payments varied widely among states, territories, and the District of Columbia, with per capita payments by state, territory, and district population ranging from $0.05 in Puerto Rico to $14.24 in New York, while 6 states received no support for dental or podiatry residency programs.

CONCLUSIONS AND RELEVANCE

These findings suggest that dental and podiatry GME represents a substantial public investment, and deliberate policy decisions are needed to target this nearly $730 million and growing investment to address the nation's priority oral and podiatry health needs.

Initial Medical Certificate: survey of post graduate students in dentistry

INTRODUCTION

The initial medical certificate (IMC) is the first document delivered to an injured person, or his or her legal representative. The objective of this study was to determine the knowledge and writing habits of Tunisian dental post-graduate students regarding the IMC.

METHOD

This was a descriptive study conducted at the Faculty of Dentistry of Monastir (Tunisia) during the period from October 1, 2018 to March 31, 2019. All the post graduate students were included in the survey. For data collection, a questionnaire written in French was used. The platform "Google Forms" was used to perform the questionnaire and the link was sent by mail to all participants.

RESULTS

For 19.9% of respondents , the IMC was considered as an expertise and 22% of them declared that even non-graduates can deliver it. In addition, 22% of participants have already given a IMC to a third party and 12.2% have reported photos and X-rays to the IMC. On the other hand, 82.4% of respondents do not indicate total incapacity for work (TIW) when writing the IMC. In fact, 13.7% of them do not know what a TIW is and 52.1% think that it will be determined during the expertise. Finally, 85.6% of respondents estimated that they did not have the necessary information about the IMC and 96.9% of them thought that an information support would be useful to help them in writing it.

CONCLUSION

The writing of IMC incurs the criminal, civil and ethical responsibility of the practitioner.

Cross-Sectional Analysis of National Dental Residency Match Data

The Dental Residency Match (DRM) program provides an ethical and unbiased selection process for applicants to postdoctoral dental programs, based on mutual interests of applicants and programs. The aims of this study were to conduct a descriptive analysis of DRM metrics for the years 2008 to 2015 and to test the hypothesis that there was a difference in number of ranks submitted between programs that filled all their offered positions and those that did not. DRM metrics data from years 2008 to 2015 were obtained from the National Matching Service. Trend analyses and panel data assessments were made. Six types of postdoctoral dental programs (GPR, AEGD, oral and maxillofacial surgery, pediatric dentistry, orthodontics, and dental anesthesiology) participate in the DRM program. The results showed that the number of programs participating and number of residency positions offered increased over the study period. The programs that filled all their positions ranked more applicants than the programs that did not fill their positions (p<0.05). The number of acceptable applicants increased over the study period for all programs except those in dental anesthesiology. These results suggest that participation in DRM is increasing, most programs are able to fill their positions with acceptable applicants, and programs seeking to fill all their positions need to submit a large number of ranks.

Nepalese dental hygiene and dental students' career choice motivation and plans after graduation: a descriptive cross-sectional comparison

BACKGROUND

This is the first study of its kind to provide data regarding the self-reported career choice motivation and intentions after graduation of dental and dental hygiene students in Nepal. The findings of this study can be used to inform future oral health workforce planning in Nepal.

METHODS

A cross-sectional survey of dentistry and dental hygiene students attending a large accredited dental college in Kathmandu, Nepal. Quantitative data were analysed using IBM® SPSS® 22. The respondents were given the opportunity to provide clarifying comments to some of the questions.

RESULTS

Two hundred questionnaires were distributed, and 171 students completed the anonymous survey (response rate 86 %). Working in health care and serving the community were the most important initial motives for career choice, with significantly more dentistry students selecting their degree course because of the possibility to work flexible working hours (p < .001) compared to dental hygiene students. A majority of the students expressed concern about finding a suitable job (58 %) after graduation. Almost a quarter (23 %) reported intent to seek a job immediately after graduation, while 46 % plan further studies. Dentistry students were more likely to report planning further studies (p = .007) compared to the dental hygiene students. Dental hygiene students express a higher interest in going abroad (p = .011) following graduation. Only 10 % of all students plan to live or work in rural areas after study. Most common preferred locations to live after graduation are urban (33 %) or abroad (38 %). Data suggest a preference to combine working in a hospital with working in their own practice (44 %) while interest in solely working in their own practice is low (<2 %).

CONCLUSION

Many students, though enthusiastic about their profession and expressing the ambition to serve the community, fear unemployment or envision better chances abroad. Most of the students in this study expressed a preference to live in an urban area after graduation. Findings indicate that strong measures are required to incentivise students to consider rural work.

Factors affecting scientific productivity of German oral-maxillofacial surgery training centers: a retrospective cohort study

PURPOSE

To identify factors associated with scientific productivity (SP) of German oral-maxillofacial surgery (OMFS) training centers.

MATERIALS AND METHODS

This retrospective cohort study was composed of a set of data from German OMFS training centers. A total of eight predictor variables were grouped into demographic, structural, and personal categories. The outcome variables were average publications in 2013 per senior staff, and percentage of OMFS trainees with >1 publications. Descriptive and univariate statistics were computed using P < 0.05.

RESULTS

The sample included outputs from 62 OMFS departments (34 [54.8 %] university-based; 46 [74.2 %] in large cities). Average publications were 2.4 ± 3 per senior staff (range, 0-27), and 160 trainees (31.7 %) published >1 papers. The number of publications and productive trainees was not linked to department name and number of female senior staffs, but publication count was significantly increased when the hospital was in a metropolis (P = 0.018) or university-based (P < 0.0001), the OMFS' chairperson and >3 staffs within the department had a postdoctoral degree (German "Habilitation") (P = 0.013 and <0.0001), and the chairperson had h-index >10 or the first/last authorship in 2013 (P < 0.0001). Female senior surgeons were less scientifically productive than the male ones (P = 0.01).

CONCLUSION

SP of German OMFS training centers is greatly different across the country and influenced by city size, university base, educational backgrounds, and research activities of chairpersons and senior staffs. This helps students, trainees, and young surgeons to reach the career choice that is personally appropriate. The involved organizations may need to encourage research output of less productive surgeons/centers. Increasing postdoctoral-qualified staffs will increase SP of the department.

Oral and maxillofacial radiologists: career trends and specialty board certification status

Oral and maxillofacial radiology is the newest specialty to be recognized by the American Dental Association, so knowledge about the parameters of this profession is in the early stages of development. The aim of this study was to understand the current distribution of oral and maxillofacial radiologists (OMFRs) in academia and private practice, the nature of their practice, and trends in their board certification status. An email describing the study's purpose with a link to a survey was sent to "OradList," a listserv that has a majority of OMFRs in the United States and Canada as members. Of the 205 respondents, 46% were female; the age distribution ranged from 25 to over 70 years; and 80% were working full-time. Among the respondents, 66% practiced in an academic setting, 20% in private practice, 8% in both private and academic settings, and 3% in the military. Only 37% of the respondents were board-certified. For OMFRs trained from 1965 to 2009, there was an increasing trend towards becoming board-certified, but a significant decrease occurred after 2009, dropping from 65% to 35% of those trained in those years.

Background, training experiences, and career plans of U.S. periodontal residents: report of a web-based survey

The purpose of this cross-sectional study was to survey the backgrounds and perspectives of U.S. periodontal residents in 2012. A 64-item web-based survey was distributed to all periodontal residents in the United States (544 residents enrolled in 54 graduate programs) via email in March 2012. Data on the residents' demographics, experiences during graduate periodontal training, and goals were collected and analyzed, and percentages were calculated. The survey had a 19.1% response rate. Most of the respondents (74%) had graduated from international dental schools, and 81.7% were in combined programs (clinical training combined with a Master's degree, PhD, or other doctoral degree). Almost one-fourth of the responding residents (24%) reported a total debt of more than $300,000 after graduation. More than 60% of the respondents planned to practice in a private setting as an associate, partner, or solo practice owner. The responding residents reported having chosen their graduate programs based mainly on the programs' clinical education and reputation (72% and 48%, respectively). Future studies will determine educational trends and outcomes for periodontal residents in the longer term.

Geriatrics education in U.S. dental schools: where do we stand, and what improvements should be made?

The number of adults above sixty-five years of age in the United States will expand considerably over the next thirty years. However, many dentists believe that their dental education did not adequately prepare them to treat an older adult population. Consequently, it is important to review dental curricula to determine where these gaps in education may occur and what can be done to address them in order to improve access to care. In this study, information was gathered from the websites of sixty-two U.S. dental schools in order to understand the types of geriatric courses offered. This review revealed that while most schools (89 percent) provide their predoctoral students with some education in geriatrics, only fourteen (22.6 percent) offer clinical training specifically for older adult care. In addition, forty-three schools (69 percent) include a geriatric component in either their General Practice Residency or Advanced Education in General Dentistry programs or have a certificate program in geriatric dentistry. Only about 23 percent of the schools offer a continuing education course in geriatrics at any one time. Previous studies have shown that clinical training is the most effective method of increasing students' confidence in treating older patients. Consequently, dental schools should work to incorporate clinical experience into geriatric education to prevent widening an existing gap in older adult oral health care.

Effects of a proposed rural dental school on regional dental workforce and access to care

INTRODUCTION

Southwest Virginia is a rural, low-income region with a relatively small dentist workforce and poor oral health outcomes. The opening of a dental school in the region has been proposed by policy-makers as one approach to improving the size of the dentist workforce and oral health outcomes.

METHODS

A policy simulation was conducted to assess how a hypothetical dental school in rural Southwest Virginia would affect the availability of dentists and utilization levels of dental services. The simulation focuses on two channels through which the dental school would most likely affect the region. First, the number of graduates who are expected to remain in the region was varied, based on the extensiveness of the education pipeline used to attract local students. Second, the number of patients treated in the dental school clinic under different dental school clinical models, including the traditional model, a patient-centered clinic model and a community-based clinic model, was varied in the simulation to obtain a range of additional dentists and utilization rates under differing dental school models.

RESULTS

Under a set of plausible assumptions, the low yield scenario (ie private school with a traditional clinic) would result in three additional dentists residing in the region and a total of 8090 additional underserved patients receiving care. Under the high yield scenario (ie dental pipeline program with community based clinics) nine new dentists would reside in the region and as many as 18 054 underserved patients would receive care. Even with the high yield scenario and the strong assumption that these patients would not otherwise access care, the utilization rate increases to 68.9% from its current 60.1%.

CONCLUSIONS

While the new dental school in Southwest Virginia would increase the dentist workforce and utilization rates, the high cost combined with the continued low rate of dental utilization suggests that there may be more effective alternatives to improving oral health in rural areas. Alternative policies that have shown considerable promise in expanding access to disadvantaged populations include virtual dental homes, enhanced Medicaid reimbursement programs, and school-based dental care systems.

Current undergraduate and postgraduate dental education in China

China is a developing country with the largest population of any country in the world. The 2010 sixth national census found that China's population was 1,339,724,852, accounting for about 19 percent of the world's total population. However, higher education in the Chinese dental field started late and developed slowly. In order to acquaint more dental educators worldwide about China's current higher dental education system, this article provides a brief introduction to the present education system, degrees conferred, curriculum setting, training mode, teaching materials, courses, and academic journals.

Pre- and postdoctoral dental education compared to practice patterns in special care dentistry

There has been limited research into the impact of predoctoral experiences and postdoctoral general dentistry residencies on the practice patterns of dentists in the care of patients with special or complex needs. This study was undertaken to determine if educational experiences with special populations had a relationship to practice patterns after graduation or residency. University of the Pacific alumni who graduated between 1997 and 2007 were surveyed regarding their pre- and postdoctoral dental education and their practice patterns for the care of patients categorized as medically compromised, frail elders, and developmentally disabled. Definitions for each patient category were provided. Alumni were asked about their practice setting and postdoctoral education. Thirty-one percent (n=526) of those surveyed responded. Regression analyses showed respondents not in private practice were more likely to have completed a postdoctoral general dentistry program (Advanced Education in General Dentistry or General Practice Residency) after dental school compared to respondents in private practice (p<0.001). Across all age groups, respondents not in private practice treated significantly more patients with developmental disabilities than those in private practice (p<0.001). Respondents not in private practice treated more medically compromised patients younger than age sixty-five compared to respondents in private practice (p<0.01). Interestingly, those in private practice treated significantly more patients over sixty-five who were also classified as medically compromised (p<0.05). Pacific alumni who completed postdoctoral training in general dentistry were found to practice more often in non-private practice settings. Alumni in non-private practice settings reported treating a higher percentage of medically compromised patients below age sixty-five than their counterparts in a typical private practice. The pre- and postdoctoral experiences of treating special needs populations appear to have a relationship to graduates' practice setting and patient population.

The role of women in dental education: monitoring the pipeline to leadership

The purpose of this study was to analyze data collected by the American Dental Association and the American Dental Education Association over the past two decades relating to changes in the number of women active in dental education and dental practice. The concept of a pipeline of women in dentistry was explored by analyzing predoctoral, postdoctoral, dental practice, and dental education domains for the inclusion of women. Statistical analyses show that there has been a consistent and progressive increase in the number of women in all stages of the pipeline. Over the past two decades, the number of female students attending and graduating from dental school has steadily increased. In 1984-85, 23.7 percent of all predoctoral students were women; in 2009-10, 45.1 percent were women. Similarly, in 1999, the graduating class was 35.3 percent women; in 2009, it was 46.1 percent women. In the postdoctoral domain, in 1996, 29.9 percent of all residents were women; in 2010, this had increased to 39.0 percent. In dental practice, the number of actively licensed women dentists in 1999 was 15.3 percent of the workforce; in 2010, this percentage had grown to 24.0 percent. In dental education, the number of women clinical faculty members has gradually increased from 669 in 1997-98 to 902 in 2007-08. Until 2000, there had been only two women deans and very few associate/assistant deans, with only sixteen in 1990. In 2000, major changes began with three women deans and seventy-two women associate/assistant deans. In 2009-10, there were 111 associate/assistant women deans and twelve women deans. These data show a progressive increase in the presence of women in all domains of dentistry, especially in leadership positions in dental education.

Application data as an indicator for post-Katrina recovery of LSU Postdoctoral dental programs

Devastated by the aftermath of Hurricane Katrina in August 2005, the New Orleans campus of the Louisiana State University School of Dentistry was closed for two years. With help from the university's Systems Office, the school created a temporary campus in Baton Rouge, seventy-five miles from the New Orleans campus. The eight postdoctoral education programs, however, were forced to find clinic and seminar space in other facilities and cities. Of the seventy-nine students in these programs, only sixteen did not continue after the storm. This article describes how each program maintained its curriculum while the main campus was closed. By comparing numbers of student applications to these programs in each year since Hurricane Katrina with the average baseline for each in the ten years preceding the storm, this article illustrates the current viability of these residency programs. Total applications in 2005-07 were significantly lower than baseline measures, but applications in 2008 and 2009 have returned to pre-storm levels. A comparison of these application numbers with national trends also demonstrates that these programs have rebounded from the effects of Hurricane Katrina.

A preliminary analysis of the US dental health care system's capacity to treat children with special health care needs

PURPOSE

The purpose of this study was to use existing data to determine capacity of the US dental care system to treat children with special health care needs (CSHCN).

METHODS

A deductive analysis using recent existing data was used to determine the: possible available appointments for CSHCN in hospitals and educational programs/institutions; and the ratio of CSHCN to potential available and able providers in the United States sorted by 6 American Academy of Pediatric Dentistry (AAPD) districts.

RESULTS

Using existing data sets, this analysis found 57 dental schools, 61 advanced education in general dentistry programs, 174 general practice residencies, and 87 children's hospital dental clinics in the United States. Nationally, the number of CSHCN was determined to be 10,221,436. The distribution, on average, of CSHCN per care source/provider ranged from 1,327 to 2,357 in the 6 AAPD districts. Children's hospital dental clinics had fewer than 1 clinic appointment or 1 operating room appointment available per CSHCN. The mean number of CSHCN patients per provider, if distributed equally, was 1,792.

CONCLUSIONS

The current US dental care system has extremely limited capacity to care for children with special health care needs.

Amalgam use and waste management by Pakistani dentists: an environmental perspective

To assess amalgam use and waste management protocols practised by Pakistani dentists, a cross-sectional study was made of 239 dentists in Islamabad and Rawalpindi, recruited by convenience and cluster sampling. Amalgam was the most frequently used restorative material, with the choice dictated by patients' financial constraints. While 90.4% of dentists perceived amalgam as a health risk, only 46.4% considered it an environmental hazard. The majority disposed of amalgam waste in the trash, down the sink or as hospital waste. Very few (5.9%) had an amalgam separator installed in their dental office. Amalgam waste management protocols and mercury recycling should be introduced in Pakistan.

Clinical experience of residents with RPD treatment in U.S. graduate prosthodontics programs

This cross-sectional study was conducted to quantify the clinical experience of prosthodontic residents with cast metal removable partial denture (RPD) treatment based on their year of training, geographic location of the program, and nature of the program. A web-based survey consisting of five questions was e-mailed to program directors from forty-two programs across the United States. A 62 percent response rate was obtained (26/42). Thirteen of the programs (50 percent of respondents) stipulated a specific number of RPDs to be done prior to completion of the program. Clinical experience of residents varied vastly based on year of training, geographic location of the program, and nature of the program. Prosthodontic residents from southern states, university-based programs, and public school programs had more clinical experience than residents from other programs. The average clinical experience for a prosthodontic resident during three years of training was eight traditional RPDs and two implant-supported RPDs. This is the first study done exploring this topic and provides baseline information on residents' clinical experience in RPD treatment. Future studies will determine educational trends and reassess this portion of the curriculum in graduate prosthodontics.

Evolving demographics of advanced dental education

The numbers of dental school graduates and students enrolled in post graduate programs have increased. Decreases are noted in the enrollment in Periodontics and Prosthodontics programs and a marked increase in the enrollment in Pediatric Dentistry programs. A review of these changes, by gender and race/ethnicity provides an overview of the future demographics of the profession. Some concerns regarding the future are considered.

Changes in orthodontic care patterns in a predoctoral children's dentistry clinic

The purpose of this study was to evaluate the changes in orthodontic care patterns over a sixteen-year period in a university clinical setting. The average numbers of students, clinical procedures, and orthodontic appliances were examined from the time period 1988-2003. Appliance number and type were evaluated as a function of increased predoctoral and postdoctoral class sizes, student to faculty ratios, and decreased operating budgets for faculty recruitment. For the period 1988-98, the insertion of orthodontic appliances by dental students remained constant. A permanent increase in the predoctoral class size occurred in 1996 without an increase in faculty support, contributing to a decline in appliance insertions by students from 1999 to 2003. This time period also saw major increases in the postdoctoral class size and a reorganization of the clinical facility that then began to require the pairing of dental students to provide comprehensive care, thus decreasing their clinical exposure to the care of children. The overall clinical experience at the predoctoral level in orthodontic procedures declined, which resulted in a change in clinical requirements and new methods to ensure clinical competency.

Geriatric dentistry: a new specialty in Brazil

OBJECTIVE

To present the current status of geriatric dentistry in Brazil.

BACKGROUND

In 2001, the Brazilian Dental Council established a new specialty: geriatric dentistry. This decision was based on the increase in both the elderly population and the demand for dental treatment of this cohort.

MATERIALS AND METHODS

Data were obtained through online searches of the Brazilian Dental Council and the Brazilian Institute of Geography and Statistics.

RESULTS

Brazil has 170 dental schools offering around 14 000 undergraduate vacancies every year. At the postgraduate level, there are 19 recognised dental specialties, one of which is geriatric dentistry, comprising 18 certificate programmes, with the potential to produce 216 new specialists every 18 months. The dentist/habitant ratio was 1:870, higher than that recommended by the Word Health Organization. The Brazilian population consists of around 14.5 million elderly people (8.6%). There were 124 specialists in geriatric dentistry distributed irregularly throughout the country. The specialist/elderly population rate was 1:117 249. At the undergraduate level, this new specialty is not included in the curricula of most dental schools in Brazil.

CONCLUSIONS

Geriatric dentistry should be included in the undergraduate curricula of dental schools in Brazil. Postgraduate degree courses should be developed to produce more clinical academics and researchers in this field.

A survey on the preference for continuing professional dental education amongst general dental practitioners who attended the 26th Asia Pacific Dental Congress

AIMS

To identify the subjects of interest and to examine the modes as well as means of study for continuing professional dental education amongst general dental practitioners who attended the 26th Asia Pacific Dental Congress, 28 May-1 June 2004, Hong Kong.

METHODS

A total of 381 general dental practitioners as the registered conference delegates from Hong Kong, Mainland China and other Asia-Pacific regions were randomly selected for the present survey. The survey was conducted through face-to-face interviews by a group of practising dentists in Hong Kong.

RESULTS

Overall, orthodontics and prosthodontics were the most popular subjects for clinical degree programmes, whilst oral implantology and cosmetic dentistry were the highly preferred subjects for continuing education courses. Concerning the preferred mode of study for degree programmes, the part-time study mode was chosen by 68.3% of the participating dentists. A didactic teaching approach was preferred by most of the participants (81.7%) for postgraduate study. The majority of the interviewees (76.5%) were interested in a proposed clinical degree programme to be offered jointly by The University of Hong Kong and a leading university in the Mainland. Overall, there was no marked difference in the preference for continuing dental education amongst the respondents from Hong Kong, Mainland China and other Asia-Pacific regions.

CONCLUSIONS

The present survey shows the currently preferred specialty areas and subjects for continuing professional dental education amongst the general dental practitioners who attended the 26th Asia Pacific Dental Congress, with didactic teaching as the most preferred mode of study on a part-time basis.

Demographics and quality profile of applicants to pediatric dentistry residencies

PURPOSE

The purpose of this study was to use Postdoctoral Application Support Service (PASS) data to study the quality and demographic trends for pediatric dentistry residency applicants.

METHODS

PASS data on grade point average (GPA) and National Dental Board Exam, Part I (NBI) scores were used to determine applicant quality. PASS demographic data included: (1) gender; (2) citizenship; (3) ethnicity; (4) previous practice of dentistry; and (5) completion of a residency or internship.

RESULTS

GPAs showed a significant increase for the 6 years investigated. NBI scores also indicated a significant increase. Significantly more females than males applied to pediatric dentistry residencies. A significant increase in US/Canadian applicants was found. Ethnicity was similar to that of dental school graduates, with minor exceptions. In several of the years studied, there were significant differences in applicants who previously practiced dentistry or completed a residency/internship vs applicants who had no such previous experience.

CONCLUSIONS

Significant increases in grade point averages and National Dental Board Exam, Part I scores suggest a high quality of pediatric dentistry residency applicants and this trend seem to be continuing. There are significantly more female than male applicants. More research is warranted on actual acceptance data.

General dentists' referrals of 3- to 5-year-old children to pediatric dentists

BACKGROUND

Little is known about general dentists' referral patterns. The authors explored the practice, dentist and patient characteristics associated with general dentists' likelihood of referring children aged 3 to 5 years to pediatric dentists.

METHODS

The authors sent all Iowa general dentists (N = 1,089) a 25-item questionnaire regarding the referral of children in their practices. The authors merged the resulting information with an existing database (Iowa Dentist Tracking System) to create the dataset. A total of 65.4 percent of the dentists (712) participated.

RESULTS

Logistic regression analysis demonstrated that an increase in the percentage of children in the practice decreased the likelihood of the dentist's referring the children (odds ratio [OR] = 0.93, 95 percent confidence interval [CI] = 0.90 to 0.96). Practices with more than 5 percent of patients with public insurance were more likely to refer children (OR = 1.96, 95 percent CI = 1.26 to 3.06), as were dentists with additional training beyond dental school (OR = 1.69, 95 percent CI = 1.06 to 2.69).

CONCLUSION

These data indicate that both practice and dentist characteristics are associated with the likelihood of making referals; however, there needs to be further study on general dentists' referral decisions.

PRACTICE IMPLICATIONS

As the characteristics of the dental work force evolve, there is a need to study referral patterns and the influence they have on work force policy, patient accessibility and educational curriculum.

Dental specialist training in South Africa--demographic characteristics 1985-2004

This short communication complements a recently published dental undergraduate analysis, and analyses the demographic profile of dental specialists trained from 1985-2004, as well as that of the registrars in training (in 2005). A total of 309 dental specialists were trained from 1985-2004, of these 86% were males and 74% White. Of the registrars, two-thirds are males and a quarter Black. The dental faculties and the Health Professions Council of South Africa (HPCSA) face a significant challenge to find innovative ways to address these disparities, as well as the urban/rural and private/public sector maldistribution of dental specialists, and to develop a more rational basis for training dental specialists for the country. Dealing with these disparities should improve access to dental specialist care for the poor and rural populations.

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.

Graduate orthodontic education: The residents’ perspective

INTRODUCTION

The purpose of this study was to identify current demographic trends of orthodontic residents, their goals for the future, and their perspectives on orthodontic training.

METHODS

A 26-item survey was conducted at the Graduate Orthodontic Residency Program (GORP) at Harvard University in August 2003. Questionnaires were distributed to residents representing 51 orthodontic programs (of 58 in the United States). Surveys were sent to 5 of the 7 programs whose residents did not attend GORP.

RESULTS

Of the 380 questionnaires distributed, 295 were completed and returned at the meeting for a 77% response rate. Additionally, 35 of the 50 mailed questionnaires were completed and returned, for a total response rate of 77% (330 completed/430 distributed). Most residents stated that clinical education was the most important factor when choosing a residency. Most residents planned to publish their research, complete American Board of Orthodontics certification requirements, and work 4 days a week after program completion.

CONCLUSIONS

Several trends were identified since orthodontic residents were last surveyed in 1992. The most significant change reported was an increase in the number of those who plan to complete American Board of Orthodontics certification requirements.

Predoctoral Implant Education in U.S. Dental Schools

PURPOSE

In 2002, a survey of American dental schools was conducted to determine the curricular structure, teaching philosophies, and materials used in predoctoral implant dentistry courses.

MATERIALS AND METHODS

The questionnaire was mailed to the predoctoral implant dentistry director/chairperson of 54 U.S. dental schools. Of these, 38 schools returned the completed survey resulting in a response rate of 70%.

RESULTS

Eighty-four percent of the respondents indicated that an implant dentistry course is part of their school's requirements. Seventy percent indicated that this course is offered by either the Restorative or Prosthodontics Department in the third year of the predoctoral dental curriculum. For 75% of the schools, the duration of the course ranged from 3 to 6 months (mean of 5.5 months), 57% reported offering between 11 and 20 lecture hours (mean of 20.4 hours), and less than half of the schools (41%) have prosthodontists teaching the predoctoral implant dentistry course. In 78% of the schools, a laboratory course is offered in conjunction with the implant course. The majority of the schools (88%) allow predoctoral students to restore implant cases clinically. Seventy-three percent require some of the implant-related laboratory work to be completed by the students and the single-tooth implant restoration is the most popular type of implant restoration for 78% of the schools.

CONCLUSIONS

Predoctoral implant dentistry educational programs vary from school to school, yet a large percentage of schools agree on certain topics.

A snapshot of the U.S. postdoctoral pediatric dentistry faculty workforce, 2002

This study characterizes the faculty shortage in U.S. postdoctoral pediatric dentistry (PD) education. The objectives of the study were to determine: 1) the changes in PD faculty numbers and teaching loads between 1995 and 2002 for postdoctoral PD education, 2) current faculty age and training, and 3) distribution of faculty by age. A questionnaire was sent in 2002 to fifty-four programs, of which forty-six responded (85 percent). Dental school and residency mean class sizes increased in the seven-year study period from 82.8 to 91.8 and from 6.0 to 8.5, respectively. Full- and part-time mean faculty positions increased as did vacancies, the latter growing from 15 to 38.9 and changing during the period from 5 to 10.8 percent of available positions. About one-third of programs used general dentists to teach PD, while programs using foreign-trained educators grew from 4 to 13 percent. Twenty-nine percent of full-time and 27 percent of part-time faculty are fifty-five years or older, and young entry-level faculty, age twenty-five to twenty-nine, represent only 2 percent and 5 percent of full- and part-time faculty respectively. Faculty vacancies have increased along with numbers of students and residents, and the largest segment of PD faculty is within a decade of retirement age.

Problem-based learning and research at the Harvard School of Dental Medicine: a ten-year follow-up

Dental students at the Harvard School of Dental Medicine (HSDM) are required to pursue and complete research projects in order to obtain the doctor of dental medicine (D.M.D.) degree. The purpose of this study was to evaluate the effect of curriculum changes on a set of measurable outcomes related to research pursuits. This study was designed as a retrospective analysis of outcomes data from the period 1992-2002. The predictor variable was program format (non-PBL vs. PBL); the outcome variables were the percentage of students listed as authors on an IADR/AADR abstract during their tenure at HSDM and the percentage of students listed as first and/or presenting authors. Univariate statistics were computed for each class, and independent samples t-tests were used to compare the study groups with regard to our outcomes. For the majority of our outcomes, there was no statistically significant difference between the PBL and non-PBL groups, possibly due to sample size limitations. While the implementation of PBL at HSDM has not universally increased student productivity in research, it has not had an adverse effect either. It is possible that students in the PBL curriculum are nurturing other interests, such as community service, while retaining productivity in research.

Research in pediatric dental postgraduate programs and residencies: results of a survey

PURPOSE

The purpose of this study was to determine various aspects of the research experiences in postgraduate and residency training programs in pediatric dentistry.

METHODS

A survey was developed and sent to all directors of postgraduate and residency training programs in pediatric dentistry. The survey consisted of 21 items on various topics related to research experiences of the postgraduate students and residents. The items varied in structure, but most contained response sets deemed appropriate for the intent of the question. The directors were asked to complete the survey and return the questionnaire in a self-addressed stamped envelope within a 3-week period. If a program did not respond within 6 weeks, a follow-up survey was sent. The response sets were collated and analyzed with descriptive and nonparametric statistics.

RESULTS

Forty of 55 programs responded with usable data sets. All reporting programs indicated that research experiences occur for residents and all have access to statistical assistance. Eighty-seven percent devote clinical hours to student research and 50% of the students share data or protocols. Only a minority (7%) of programs has not published student research in the last 5 years. Interference with revenue-generating clinic times (45%), lack of faculty understanding/interest in research (40%), and lack of financial resources (32%) were the 3 major obstacles for postgraduate research.

CONCLUSIONS

Despite research being accomplished in postgraduate programs in pediatric dentistry, variability in key factors (eg, devoted research time) is common among programs. The impact of this variability on the profession and its advancement of scientific endeavors are unknown.

Building the minority faculty development pipeline

The shortage of faculty in dental education is well documented, but the data also show a shortage of minorities in postgraduate programs, which develop future faculty. In the last ten years, ADEA's effort to address minority issues in dental education has made some progress. In addition, examples of pipelines for minority faculty development that have shown some success include: a partnership between Harlem Hospital and Columbia University School of Dentistry and Oral Surgery in which the school dedicates one position in its postgraduate training programs to an individual participating in the Harlem Hospital General Practice Residency program; a partnership between the National Dental Association Foundation and Colgate-Palmolive Company, which provides scholarships for advanced dental education study; and the Bronx Lebanon Hospital Center Department of Dentistry, which enrolls underrepresented minorities in its General Practice Residency Program, a new Pediatric Dentistry Residency Program, and a unique program providing hands-on experience in HIV/AIDS health care policy and AIDS development management. Critical elements in the relative success of these programs are environment, selection criteria, mentoring, networking, and finance. The true measure of the outcomes is still to be seen.

Radiographic equipment and techniques used in general dental practice: a survey of general dental practitioners in England and Wales

OBJECTIVES

The aims of this study were to determine the self-reported use of panoramic radiography, D- and E-speed film, rectangular collimation, film holders, equipment fitted with a long spacer cone (>200 mm) and the bisecting angle and paralleling techniques by general dental practitioners and to see if use was related to the dentists' age and postgraduate qualifications.

METHODS

Three mailings of a self-completion questionnaire were circulated to 800 general dental practitioners working in the National Health General Dental Service in England and Wales.

RESULTS

A response rate of 74% was achieved. Sixty-one percent of general dental practitioners reported use of panoramic equipment. Fifty percent of dentists always used E-speed film and 18% always used rectangular collimation. Sixty-eight percent of dentists always used bitewing film holders though fewer (37%) used periapical film holders. Sixty-three percent of dentists always used a long cone. The bisecting angle technique was used by 70% of dentists with 22% always using this technique for periapical radiographs. Thirty-one percent always used the paralleling technique. Use of panoramic equipment, periapical film holders, bisecting angle and paralleling techniques were associated with the dentists' age. Use of periapical film holders, bisecting angle and paralleling techniques and rectangular collimation were associated with dentists' postgraduate qualifications.

CONCLUSIONS

There are several features of radiographic equipment and techniques that can aid high quality imaging and reduce patient dose. Although a number of these are being used in general dental practice in England and Wales they have yet to achieve universal adoption.

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.

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.

Trends in dental specialty education and practice, 1990-99

Policy issues related to dental specialty education and practice have been the responsibility of the American Dental Association's Council on Dental Education and Licensure. In 2001, the council concluded a comprehensive study of the ADA-recognized dental specialties that included a review of specialty practice and the practice environment, membership in specialty organizations, requirements and trends in board certification, advances in research and technology related to each specialty, and trends in advanced specialty education. This paper provides an overview of the results of this study and the council's analysis of data and information provided by the dental specialty organizations and the ADA Survey Center with an emphasis on dental specialty education. The council concluded that none of the dental specialties should be considered for rerecognition, but identified concerns regarding the shortage of qualified faculty and educational program directors. As a result of the council's study, recommendations have been made to the dental specialty organizations and ADA-recognized dental specialty certifying boards that they continue to monitor the number of board-certified specialists and identify ways to increase the number of board-certified specialists.

Attitudes and trends of primary care dentists to continuing professional development: a report from the Scottish dental practitioners survey 2000

OBJECTIVES

To describe the current and intended continuing professional development activity of dentists in general and community practice.

DESIGN

A cross-sectional survey by postal questionnaire.

METHODS

A semi-structured questionnaire was sent to all general practice and community dentists identified from the dental practices division as being in practice in Scotland. The issues addressed included personal demographics, current working patterns and job satisfaction, training and professional development and finally career and working intentions.

RESULTS

Of the 1,917 questionnaires sent to general dental practitioners (GDPs), 1,357 were returned useable (70% response rate); 212 of the 283 questionnaires to community dental practitioners (CDPs) were returned giving a 75% response rate. Of the responders, 89% of GDPs (1,188) and 95% of CDPs (178) reported participating in some form of CPD in the preceding year. One sixth of GDPs (211) and one third of CDPs (62) had a further qualification. Short courses such as Section 63 were very popular with over 90% of GDPs, but more than half the respondents did not think that further qualifications would enhance their career prospects. The most commonly identified barriers to further qualifications were heavy clinical commitments (78%), with 73% citing the substantial cost with no additional benefit. Over a third of GDPs under the age of 30 indicated they intended to sit a postgraduate qualification, but this fell to 12% for those aged over 30. The number of dentists identified on a career break was low (18).

CONCLUSION

Two years before implementation of the General Dental Council's mandatory revalidation scheme, over 90% of Scottish primary care dentists reported active participation in continuing professional development. Future initiatives must be sufficiently sophisticated to fulfil the educational needs of different age groups, and to focus on part-time and career break dentists as well as full-time practitioners. It is important to establish career pathways in dental primary care. Part-time modular courses such as Masters degrees in primary care based dentistry may be one solution. An increased number of part-time posts for primary care dentists in secondary dental care may increase the skill base and also increase service provision in secondary care establishments. These pathways should create an opportunity to adequately reward those who continue to develop the knowledge and skills necessary for a technically demanding healthcare profession.

Trainees' perceptions of UK maxillofacial training

Training is a central component of the work of many units around the UK. Many changes to the way that junior doctors are trained have taken place over the past few years and maxillofacial surgery, of all the surgical specialities, has perhaps undergone the most far-reaching. A postal survey of 93 maxillofacial specialist registrars (SpRs) in all regions of the UK was carried out, of whom 81 (87%) responded. The aim was to seek their views on subjects directly related to the quality of, and access to, training. Information was gathered on age of trainees, entitlement to annual and study leave, certification for Advanced Trauma Life Support (ATLS) and office and research facilities.

Workforce and planning issues for the profession of periodontics in Australia and New Zealand

The speciality of periodontics in Australia and New Zealand has seen steady growth since 1986, when the Australian and New Zealand Academy of Periodontics (ANZAP) was formed. Very few members of ANZAP have retired in the 16 years since its formation. However, the results of a survey of members revealed that one-third of members plan to retire within the next 10 years, and over 50% of members will have retired within 15 years. The survey also revealed that most members were heavily booked, and nearly half were concerned by their level of busyness. A total of 22 members are currently seeking to employ a periodontist in their practice, and yet only three students will complete the MDSc program in periodontics in Australia at the end of this year. This paper presents the results of the ANZAP survey of members and addresses issues affecting the training of periodontists in Australia and New Zealand.

Critical issues for dentistry: PGD program directors respond

Discussion of critical issues facing postgraduate education in general dentistry (PGD) and dental education in general has been intense in the past decade. This study reports on critical issues raised by directors of PGD programs that may help direct future research and action within dental education and the larger profession. The analysis reports responses to an open-ended question sent to all U.S. PGD program directors regarding critical issues facing their training programs. Of 212 surveys, 169 program directors submitted written responses regarding critical issues. Twelve unique themes were identified: lack of postdoctoral applicants (two subthemes were high student debt and students' preference for private practice); student quality; professionalism and attitudes; number of postdoctoral positions; lack of funding; quality of facilities; special patient care; program curriculum; educator issues; mandatory or encouraged PGD year; value of dental program; and dentist shortage. Significant differences between AEGD and GPR directors were observed for two of the twelve areas: high student debt and value of dental program. The study provided insight into the thoughts of a large proportion of the U.S. PGD program directors "in the trenches." Some consideration of allowable expenses may be needed to align federal training support to best address program director needs.

Looking for a job? Try dental education

The decreasing number of dentists entering a career in academia is considered in terms of the evolving changes in the general setting for dental education.

Orthodontic graduate education survey, 1983-2000

Throughout academic year 1999/2000, the fourth in a series of national surveys sponsored by the American Association of Orthodontists Council on Education was conducted to determine the status of graduate education, to assemble information on the didactic and clinical material being taught, and to provide a basis for comparison with past and future studies. The results of the previous studies were published in 1984, 1989, and 1995. The specific purpose of the 2000 study was to identify trends and evaluate new developments in orthodontic education over the past 17 years. A 346-item survey questionnaire, covering 8 major areas of orthodontic graduate education, was sent to graduate program directors in the United States and Canada. The major areas analyzed were program organization, graduate students, faculty, facilities, clinical details, treatment techniques, research, and curriculum. Findings showed that curricular time devoted to clinical activities is increasing, but curricular time devoted to research is declining. The rate of student publications is down precipitously. The numbers of full-time and half-time faculty members are declining, and departments increasingly rely on part-time faculty to meet teaching needs. Overall experience levels of the faculty are declining. Fewer faculty members are American Board of Orthodontics diplomates. Faculty salaries, when adjusted for inflation, are down from 1994. Tuitions have increased dramatically over the last 5 years. Approximately 50% of all programs are now 3 years long. Clinic fees are now roughly two thirds those of local private-practice fees. Students are treating more mixed dentition and craniofacial cases and fewer nonsurgical adult cases. Fewer departments are relying on centralized radiographic facilities in their parent dental schools, preferring in-department radiography. Approximately 50% of the first-year students are female.

Experiences and perceptions of vocational training reported by the 1999 cohort of vocational dental practitioners and their trainers in England and Wales

OBJECTIVE

To assess the self-reported confidence of vocational dental practitioners (VDPs) in clinical procedures together with vocational trainers' perceptions of the VDPs confidence in the same procedures, immediately after qualification and towards the end of the vocational training year.

DESIGN

A questionnaire-based cohort study.

SETTING

A general practice study carried out in 1999.

SUBJECTS

Vocational Dental Practitioners and vocational trainers in England and Wales.

METHOD

VDPs and trainers were asked on a single occasion to grade the clinical confidence of the VDP at the beginning and near the end of vocational training as high, satisfactory or low.

RESULTS

Questionnaires were sent to 531 VDPs and 555 trainers; 82 per cent of VDPs and trainers responded. Approximately half the VDPs were male and 57 per cent were white, whilst 89 per cent of trainers were male and 81 per cent white. A large proportion of both VDPs and trainers reported low confidence in orthodontics, molar endodontics and surgical extractions at the start of the training year. Towards the end of training, both groups reported improved confidence levels in most clinical procedures. However, a higher proportion of trainers reported low confidence than their VDPs in most clinical procedures at both time points (p<0.001). VDPs appeared to gain most from experience and training in administration/management and interpersonal skills.

CONCLUSION

Vocational training appears to satisfy its aim to enhance clinical and administrative confidence.

Endodontic standards in general dental practice--a survey in Birmingham, UK, Part 2

A postal questionnaire was used to ascertain the views of practitioners on postgraduate education, and on the way they performed endodontic treatment. Attendance at postgraduate courses was low and was influenced by the style and content of courses as well as financial considerations. Hands-on courses were the preferred mode of delivery for postgraduate education. Most practitioners wished to change the way they carried out their endodontic treatment, and the majority felt this could only occur with an increase in fees.

Perceptions of vocational trainees on gender and racial disadvantage within the Thames vocational training programme

BACKGROUND

A recent report has suggested that vocational trainees within London experienced racial or gender disadvantage during their selection. This exploratory study did not investigate the extent or the nature of this disadvantage.

AIM

To undertake a survey using a pre-tested questionnaire with dental vocational trainees on the Thames Scheme. The questionnaire explored perceived and experienced aspects of gender and racial disadvantage during their vocational training programme.

RESULTS

127 trainees completed the questionnaire (response rate 92%). Minority ethnic respondents were more than twice as likely to feel their selection was influenced by gender (odds ratio [OR] 2.25, 95% Confidence Interval [CI] 1.02, 5.10) and more than three times likely to feel selection was influenced by their race when compared with their white colleagues (OR 3.05, 95%; CI 1.01,11.45). The majority of trainees did not perceive any disadvantage whilst on the vocational training course. For example, only five respondents (4%) felt that minority ethnic individuals were treated less favourably during the vocational training course.

CONCLUSION

In conclusion, this preliminary study has attempted to explore inter-ethnic differences within the profession on perceived racial disadvantage and possible strategies for change. It is clear that the perception of disadvantage is greater than the reality within the experience of most trainees.

[Manpower shortage in oral and maxillofacial surgery--a serious problem in the Netherlands]

In the Netherlands there is currently a shortage of oral and maxillofacial surgeons. This shortage will increase between 2001 and 2010. It is analyzed that early retirement and reduction of working hours are the major factors which contribute to the shortage which will cause serious problems till 2010. Solutions will focus on increasing training capacity, reduction of training time and on various forms of substitution.

[Human resource planning in orthodontics]

Content and background of the Capacity report 2001 for orthodontics in the Netherlands are discussed. The final conclusion of this report is that there is a yearly need of an input of 12 to 15 residents into postgraduate orthodontic programs. At the moment capacity of postgraduate training programs in the Netherlands is 4.5 resident yearly. Discussion is focussed on the advantages and disadvantages of the model used for the calculated estimations. More research on certain aspects of treatment need and demand is necessary. Implementation of the outcome will be a complex process for every party in the orthodontic field.

Undergraduate orthodontic & paediatric dentistry education in Europe--the DentEd project

As a result of a European Union funded project (DentEd), a programme of visits to dental schools throughout Europe has been underway since 1998. This report describes the philosophy behind DentEd, gives a brief description of the features of a visitation, and covers the orthodontic and paediatric dentistry teaching as reported in 26 different dental schools in 16 different countries. It is based on a report submitted to DentEd from a small working group that looked at various aspects of educational provision within the two disciplines across Europe. The value of this information to teachers within the two disciplines and to the wider dental community is briefly discussed. The report recommends the adoption of an integrated course for orthodontics and paediatric dentistry. The main objectives are that the student should be able to understand orofacial and psychosocial growth and development of the child, recognize aberrant growth and development, and manage the behaviour of the child, their straightforward preventive, restorative and occlusal needs, and to make appropriate and timely referral.