Trends in postgraduate dental training in the United States

OBJECTIVE

This study examines the individual, educational, and policy factors that predict dentists pursuing postgraduate dental (PGD) training.

METHODS

Individual dentist records from the 2017 American Dental Association Masterfile were linked with pre-doctoral training attributes and state-level dental policy factors. Generalized logistic models, adjusted for individual, educational, and policy factors, were used to predict: (1) attending any PGD program, and (2) primary (i.e., advanced general practice, pediatrics, or dental public health, per the Health Resources and Services Administration [HRSA]) versus specialty care.

RESULTS

The majority of new PGD residency slots (77%) were in primary care. Women held 56% of primary care slots; men held 62% of specialty slots. Individual characteristics that predicted PGD primary care training included being Black, Hispanic, Asian, or other race; being male or older age reduced the odds. Pre-doctoral school characteristics that predicted PGD primary care training included having a pre-doctoral HRSA grant, affiliation with an academic medical center, and being a historically Black college/university; being a private school or in a small metro area lowered the odds. At the policy level, the strongest predictors of attending PGD primary care training are a residency requirement in the state you currently practice in and federal graduate medical education (GME) investment per residency slot.

CONCLUSION

Pursuing PGD training is variable based on the race/ethnicity/gender of the dentist. Federal investments in pre-doctoral dental education and GME can drive equity, as they significantly increase the odds that dentists will go on to PGD training, as do state licensure requirements.

Development of undergraduate gerodontology courses in Austria, Switzerland, and Germany from 2004 to 2009

The growing number of individuals over the age of sixty-five with specific dental needs requires increased teaching efforts to adequately prepare predoctoral dental students. The study assessed whether such increases in undergraduate gerodontology teaching in German-speaking countries between 2004 and 2009 occurred. Questionnaires were mailed in 2004 and 2009 to all deans (n=37) and all department heads (n=140) of Austrian, Swiss, and German dental schools. Results show that gerodontology is still mostly included in traditional core subjects but that specific lecture series and practical teaching have increased. These cover a broad variety of subjects including geriatric medicine, gerontopsychiatry, nursing care, pharmacology, and public health. The number of departments with dedicated staff for gerodontology, research activities, and mean number of publications has increased. Barriers to the further integration of the subject include its continued exclusion from final examinations in Austria and Germany. Guidelines of the European College of Gerodontology (2009), which aim to prepare students to provide dental treatment to seniors by teaching theoretical knowledge, practical skills, patient management techniques, and the ethical foundation of gerodontology, need to be implemented. Continued professional education of faculty in all departments, intensified cooperation between universities, and the presence of faculty specializing in gerodontology are suggested.

[Medically compromised patients in the dental office: demographics and progress in health care]

Due to changing demographics in our society, there are an increasing number of patients with risk factors presenting for dental care. Unfortunately valid screening instruments to identify these patients are lacking. Especially in elderly patients, there is often an association between the high number of prescribed medications and oral symptoms. Using supportive therapy in oncology (e.g., radio(chemo)therapy) as an example, the role of modern dentistry and its interaction with general medicine is illustrated. Modern substances, e.g., antiangiogenetics, with still unknown side effects represent challenging new developments in the field of oral medicine. Even with some examples of positive representation of patients with risk factors in the health systems, e.g., § 28 SGB V, it is clear that the pressure on the costs in the health systems leads to an undertreatment of patients with risk factors. Only by adapting dental and postgraduate training with respect to these aspects, together with better financial reimbursement of the additional efforts, will this trend be overcome.

The future of pediatric dentistry advanced education: the need for change in training standards

This report describes the background, rationale and process for revision of training standards for advanced educational programs in pediatric dentistry in the United States.

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.

The use of an evidence-based portfolio in the management of change in dental practice

In this paper the author gives his opinion about the problems of getting practices to change systems in order to institute clinical governance. There are many reasons why practices need to change and for this change to be monitored. This paper explains the need for change and the use of the evidence-based portfolio, which is produced by candidates for the Membership of the Faculty of General Dental Practice (UK) [MFGDP(UK)] examination. It can also be produced by individuals who are not taking the MFGDP(UK) examination in conjunction with the Faculty of General Dental Practice (UK)'s key skills programme. It provides a mechanism for demonstrating change and for assessing the quality of care provided by a general dental practice. The author concludes that the evidence-based portfolio will enable a practitioner to apply clinical governance in a practical way.

Flexible learning: the future of postgraduate dental education

Although mandatory CPD has long meant that dentists have had to keep their skills up to date, a growing number of GDPs are now also undertaking further postgraduate training such as diplomas and masters degrees. This article outlines the increasing range of options available to those wishing to develop their skills further.

Trends in dental and allied dental education

BACKGROUND

Educational programs play an important role in preparing a qualified dental work force. This article reviews the current status and trends in dental, advanced dental and allied dental education programs in the United States and examines their impact on the dental work force.

OVERVIEW

This analysis focuses on survey data collected by the American Dental Association during the past 10 to 15 years and compares recent patterns in applications, enrollment and graduation with previous trends. The numbers of educational programs, applicants, enrollees and graduates have increased in dentistry, dental hygiene and dental assisting, while dental laboratory technology has declined in all measures. The proportion of women in dentistry has increased, while the ethnic profile of dental and allied personnel has shown little change. Both the cost of dental education and student debt continue to increase.

CONCLUSIONS

Despite increases in the number of educational programs and overall numbers of graduates from dental and allied dental education programs, the proportion of underrepresented groups still lags behind their representation in the overall population, and the number of allied personnel falls short of practice needs.

PRACTICE IMPLICATIONS

Patterns in applications, enrollment and graduation are important determinants of the dental and allied dental work force. The cost and funding of education significantly affect the attractiveness of dental careers and the sustainability of educational programs and should be monitored carefully by the profession.

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.

Trends in special care training in pediatric dental residencies

Pediatric dentist are often regarded by the dental community as the specialty group best prepared to treat patients with developmental disabilities. This may be because it is the only specialty that receives formal training in behavior management techniques. A questionnaire was mailed to the directors of all 55 ADA-accredited pediatric dental residency programs in the U.S. The purpose of the survey was two-fold: the first aim was to quantify the training that pediatric dental residents receive in providing care to persons with developmental disabilities. A second area of investigation addressed the issue of pediatric dentist continuing yo treat persons with developmental disabilities into adulthood. The survey determined that pediatric dental residency programs provide considerable training in "Special Care" dentistry. While adults with developmental disabilities continue to be treated in 48 percent of responding programs, 55 percent of the program directors stated outright that it should not be the role of pediatric dentist to provide treatment to this population.

Reflections on changes in geriatric dentistry

The development of geriatric dental education programs in the United States and at the University of Iowa over the last twenty years is reviewed. The program at Iowa evolved from a didactic elective program taught by a single faculty person to required didactic and clinical programs that include a special care clinic in the dental school and a mobile unit with portable equipment serving ten area nursing homes with comprehensive care. Factors influencing the curriculum development are identified and discussed, and as no dental schools are the same, some general applications are suggested from the Iowa experience.

[Professional profile of the established oromaxillofacial surgeon]

To qualify for further specialist training as a maxillofacial surgeon, a licence to practice in general medicine as well as a licence to practice in dentistry must be obtained beforehand. In addition to the 4-year course to qualify, maxillofacial surgeons can gain the additional qualification in the field of "plastic surgery" in a further course lasting 3 years. By the end of 1998, there were 698 maxillofacial surgeons in private practices in Germany in comparison to 322 hospital-employed maxillofacial surgeons. Of the work done by maxillofacial surgeons (in private practices), 28% is in contracted hospitals; this percentage is relatively high in comparison to other disciplines in which private specialists use contracted hospitals. It is impossible these days for an individual specialist to completely cover all areas of maxillofacial surgery. In our field, joint practices with an internal specialization will increase the spectrum and quality of treatment in the future and will counteract competition from hospital-employed specialists now that day-case surgery has been introduced in these hospitals. Further training by the individual will remain an indispensable necessity as well as personal involvement by every maxillofacial surgeon in the postgraduate medical training of doctors and dentists. This can only be achieved if the economic situation of specialists is maintained in health-politics.

[Dentistry: the twentieth century and the future. Opinions of Dutch dentistry professors]

The main objective of this study was to investigate the opinions of Dutch dentist professors about the main developments in dental science and Dutch dental care in the period 1900-2000 and their expectations for the coming 25 years. In the Dentist Directory of the Dutch Dental Association 51 professors were found of which 23 were still active; 45 were interviewed. The answers were categorized into 5 groups. The majority of the respondents (n = 31) mentioned as the most important development in dental science in the past century the gathered knowledge of the preventive effects of fluoride and the wide application of it in practice. The foundation of the dental health insurance in the Dutch National Health system was seen as the most significant development in Dutch dental care in this period (n = x32). More than half of the group (n = 26) was worried about the future demand of dentists and about the coming problems of supply and demand of dental care. It is concluded that the results of this study seem to be an accurate representation of the opinions of Dutch dentist professors on the main developments in dental science and Dutch dental care in the period 1900-2000. Respondents were pleased with the dental advances in the past century but they felt uneasy for the coming 25 years, especially concerning the issue of the availability of dental care for the majority of the Dutch population.

Postdoctoral education in dentistry: preparing dental practitioners to meet the oral health needs of America in the 21st century

There has been increasing interest in the organization and accreditation of Postdoctoral General Dentistry Programs (PGD). In addition, numerous national organizations have called for increases in the number of first postdoctoral year (PGY-1) positions and programs. At the same time there has been a movement to incorporate concepts of competency-based education into dental education programs in order to stress the outcomes of education rather then the process. These movements have coincided with an increased recognition that dental education will be affected by the changing demographics of our population, the emerging trends in health care delivery and financing, and the need for an increase in the number of primary care providers in dentistry, trained at an advanced level, who are capable of caring for an increasingly socially diverse and medically complex population in our country in the next century. This paper reviews the history of postdoctoral education programs in dentistry and medicine with a focus on PGD education, describes the changing health care environment in which future dental professionals will practice, and relates the dental postdoctoral experience to that in medicine. A strategy is presented for the dental profession to prepare dental practitioners with the competencies needed for the future and to create enough training opportunities to prepare these practitioners to care for the oral health needs of the nation. This proposal calls for a "National Consensus Development Conference on the Future of Postdoctoral Primary Care Education in Dentistry". This conference would define the strategies necessary to prepare dental practitioners with the competencies needed for the future and develop approaches to create enough training opportunities to prepare these practitioners to care for the oral health needs of the nation.

[The development of dental research in the Netherlands]

From the acquisition of an academic status (ius promovendi) in 1947 till now, dental research in the Netherlands has reached maturity. An even increasing body of PhD-theses and publications have found their way towards the international scientific dental community. Since the early nineties most research groups have been brought together in the 'Interuniversitaire Onderzoekschool Tandheelkunde' (Netherlands Institute for Dental Sciences), a collaboration of the academic dental institutions in Amsterdam, Nijmegen and Utrecht.

[Fifty years of dissertations by dentists]

From 1947 the faculties of dentistry of the Dutch universities are entitled to grant Ph.D. grades for dental theses. In the fifty years that have elapsed since, about 500 dentists defended their thesis; the vast majority (6/7) during the second half of the period. This article describes the first thesis (dating from 1956-1973) of each of the five dental faculties that have existed in the Netherlands, followed by a short analysis of the entire group of 500 dissertations. In recent years dissertations are hardly ever written in Dutch, English taking over nearly entirely. Subjects in the field of social dentistry seem to loose foot. The increase in numbers of dental dissertations is stagnating (at a level of 20-30/year), just as is the case for medical theses (600-700/year).

Trends in postgraduate education in general dentistry

The explosion of knowledge coupled with a more diversified society have led to a new set of demands on dentists. For more than 20 years, dental educators and the profession have been concerned about the pressure on the university to ensure that every new graduate is fully competent to enter a dental practice independently and successfully. This paper reviews some of the innovations which are being employed to attempt to deal with these concerns. There is no one formula that can answer these concerns. Postgraduate training in general dentistry is becoming more widespread and may need further investigation. The main focus of this paper is on trends in formal advanced postgraduate training in general dentistry.

Program directors' opinions on the competency of postdoctoral general dentistry program graduates

Meeting the demand for postdoctoral general dentistry programs will require new, innovative, and flexible models. Many believe that these new models must be competency-based and focus on the outcomes of postdoctoral general dentistry training rather than on the structure and process of that training. The Section on Postdoctoral General Dentistry of the American Association of Dental Schools formed a broadly representative working group in the fall of 1994 to develop a set of competency and proficiency statements describing graduates of postdoctoral general dentistry programs. PGD program directors were then surveyed to determine the extent to which they felt these competencies matched their concepts of the PGD graduate. Between 44 and 65 competency statements that were rated highly by program directors could serve as the basis for a "core" set of statements to describe the abilities of graduates of postdoctoral general dentistry programs. These data should stimulate further discussion among educators, program directors, accrediting bodies, and government agencies about the future of postdoctoral general dentistry programs.

The growth of postdoctoral general dentistry programs

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