Kaizen: The key to Japan‚s competitive success

The U.S. surgeon general issued a landmark report in 2000, Oral Health in America, which described the poor oral health of our nation as a “silent epidemic.” While there have been notable improvements in the oral health of Americans, oral diseases remain prevalent across the country, posing a major challenge for the U.S. Department of Health and Human Services (HHS). These dire circumstances could be improved if HHS strengthened its commitment to oral health, made it a national priority, and partnered with other stakeholders. In 2009, the Health Resources and Services Administration (HRSA) asked the Institute of Medicine (IOM) to assess the current oral health care system and recommend strategic actions for HHS agencies. The IOM convened a committee to explore how HHS can enhance its role as a leader in improving the oral health and oral health care of the nation.

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Advancing oral health in America

The scarcity of full-time clinical faculty members in dental schools across the country is a major crisis confronting dentistry. Dental schools are experiencing critical faculty shortages and are struggling to maintain appropriate faculty to student ratios. The adage of “doing more with less” applies, in many ways, to dental schools and their mission of educating future dentists. Solutions to the problem have included plans to recruit, develop, and mentor faculty members. However, progress has been slow. Dental schools have created incentive programs to help with faculty shortages and develop future educators in dentistry. This requires commitment and resources and will take years before these efforts and their impact can be assessed. Creative solutions need to be developed both nationally and locally to reverse the trend more rapidly.

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Recruitment, Development, and Retention of Dental Faculty in a Changing Environment

The aim of this study was to survey ten graduating classes at Harvard School of Dental Medicine regarding students' specialty choice and factors influencing that choice. Students were surveyed once in 2008 (for the Classes of 2007-11) and again in 2013 (for the Classes of 2012-16). A prior article reported results regarding students' interest in and experiences with prosthodontics; this article presents results regarding their interest in all dental specialties and factors influencing those interests. Of a total 176 students in the Classes of 2012-16, 143 responded to the survey, for a response rate of 81%, compared to a 95% response rate (167 of total 176 students) for the Classes of 2007-11. The results showed that orthodontics was the most popular specialty choice, followed by oral and maxillofacial surgery. From the 2008 to the 2013 survey groups, there was an increase in the percentages of students planning to pursue oral and maxillofacial surgery, pediatric dentistry, and postdoctoral general dentistry. The educational debt these students expected to accrue by graduation also increased. The largest percentage of students chose "enjoyment of providing the specialty service" as the factor most influencing their specialty choice. "Prior dental school experience" and "faculty influence" were greater influences for students pursuing specialties than those pursuing postdoctoral general dentistry. Increased interest in particular disciplines may be driven by high debt burdens students face upon graduation. Factors related to mentoring especially influenced students pursuing specialties, demonstrating the importance of student experiences outside direct patient care for exposure to the work of specialists beyond the scope of predoctoral training. This finding suggests that dental schools should increase mentoring efforts to help students make career decisions based not on financial burden but rather on personal interest in the specialty, which is likely to have a more satisfying result for them in the long run.

Factors Influencing Dental Students’ Specialty Choice: A Survey of Ten Graduating Classes at One Institution

Dental schools in the Pipeline, Profession, and Practice: Community-Based Dental Education program that increased the number of underrepresented minority (URM) and low-income (LI) students in their predoctoral programs used focused approaches in their outreach, recruitment, and retention initiatives. Various combinations of approaches were used by the fifteen schools that received funding during Phase I of the program, which spanned 2003 to 2007. URM enrollment in the Pipeline schools increased from 184 students in 2003 to 246 in 2007. These enrollment numbers represent 16 and 20 percent of the first-year class in the Pipeline schools in 2003 and 2007, respectively. If the historically minority-serving institutions--Howard University College of Dentistry and Meharry Medical College School of Dentistry--are removed from these totals, the numbers changed from 100 in 2003 to 144 in 2007, representing 10 and 13 percent of the first-year classes. This chapter describes the approaches used by the fifteen Pipeline schools to increase the number of URM and LI students recruited to and enrolled in their predoctoral programs. It describes the internal infrastructural and organizational approaches these dental schools used to increase awareness about oral health careers among URM and LI students and to recruit applicants from these populations to their educational programs. The effective partnerships and collaborations these dental schools established with each other and external stakeholders to bolster their career outreach and recruitment efforts and some of the informal efforts that supported increased diversity are also examined.

Components of Effective Outreach and Recruitment Programs for Underrepresented Minority and Low-Income Dental Students

This article reviews current dental education economic challenges such as increasing student tuition and debt, decreasing funds for faculty salaries and the associated faculty shortage, and the high cost of clinic operations and their effect on the future of dentistry. Management tactics to address these issues are also reviewed. Despite recent efforts to change the clinical education model, implementation of proposed faculty recruitment and compensation programs, and creation of education- corporate partnerships, the authors argue that the current economics of public dental education is not sustainable. To remain viable, the dental education system must adopt transformational actions to re-engineer the program for long-term stability. The proposed re-engineering includes strategies in the following three areas: 1) educational process redesign, 2) reduction and redistribution of time in dental school, and 3) development of a regional curriculum. The intent of these strategies is to address the financial challenges, while educating adequate numbers of dentists at a reasonable cost to both the student and the institution in addition to maintaining dental education within research universities as a learned profession.

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M. Miles Beach

Papers

Dental Education Economics: Challenges and Innovative Strategies

Dental education economics