Technology Education and Training: The Need for a Comprehensive Plan
As dental technology grows at exponential rates the practice of dentistry is becoming more complex every day. Today’s multifaceted technologies not only include computer hardware and software, but also such advanced tools as 3-dimensional (3-D) imaging, guided implant systems, virtual articulators, surgical and therapeutic lasers, digital impression systems, and CAD/CAM systems, to mention a few.
When considering incorporating a new technology or system into a practice, a comprehensive plan needs to be established in order to achieve maximum benefit. Too often in the process of evaluating and selecting technology for the dental practice, the necessity, availability, and value of training for the clinicians and the entire team are overlooked, or even worse, ignored. Sales representatives tend to emphasize—and sometimes over-emphasize—the simplicity and ease of use of the technology. As highly educated professionals, it is often presumed that clinicians have an in-depth knowledge of new dental technologies, and sometimes they can feel intimidated—as if they should already know how the latest equipment works—and fail to ask about any necessary education and training.
Even today, pre-doctoral and post-doctoral dental education programs offer limited exposure to current advanced clinical and administrative technologies. The curriculums of these programs often have a limited amount of time and are already consumed with the core components of the educational program. Even if time was available, the diversity and ever-changing enhancements and components of today’s advanced technologies make it virtually impossible to provide the comprehensive knowledge and expertise required to attain the optimum outcomes desired from the many types of modalities available.
Required Education and Training
Most dental practice acts do not designate the exact amount or type of continuing education required for any specific procedure or technology. However, all dental practice acts contain a statement that says, in effect: dental professionals may perform procedures that are within their scope of practice and in a manner that is safe, effective, and consistent with the clinician’s education, training, and experience. This requirement does not pertain just to the clinical treatment performed but to all aspects of care, including patient management, records, assessment, and infection control procedures.
The manuals, CDs, and DVDs that manufacturers typically supply with the devices are usually great sources of basic information. This can be particularly true for initial installation and setup. However, as most dentists can no doubt attest, oftentimes the supplied information gets lost or ignored until a problem occurs and is not available when needed. Additionally, while the Internet can be a valuable resource for information and serve as a means of gaining further knowledge, neither the Internet nor the materials provided with the devices, by themselves, can compare to device-specific hands-on training for meeting the educational needs required for today’s advanced technologies.
While it is important to gain a thorough understanding of the benefits a technology can provide, it is imperative that the practitioner understands a technology’s limitations, weaknesses, and potential dangers. Training should be device-specific and lead by an instructor who is highly knowledgeable of true scientific principles and the individual functionalities and nuances of the technology being implemented. Ideally, the instructor should be someone who routinely utilizes the technology on a regular basis.
In the case of clinical technologies the training needs to be in-person with a hands-on component, where appropriate, with an instructor who is of an equal or higher professional level as the clinician being trained. In today’s highly litigious society where malpractice suits are commonplace, in the event of a medical-legal situation when asked how they were educated and trained on the device or procedure in question, imagine a clinician responding that they learned how to perform the surgery on the Internet by watching a YouTube video, or “that’s how the sales rep said to do it.”
The American National Standards Institute (ANSI) has established safety and training standards on various forms of technologies and devices such as lasers1 and radiography devices, as well as many other dental technologies and protocols.2 These standards not only include training guidelines for clinical procedures but also standards for the required maintenance, documentation, and infection control procedures that need to be followed. When implementing new systems, everyone in the practice must be educated in, understand, and comply with all the appropriate standards and regulations. These not only include ANSI standards, but also Occupational Safety & Health Administration (OSHA), Centers for Disease Control and Prevention (CDC), US Food and Drug Administration (FDA), and other federal, state, and local laws and regulations. In medical-legal situations these are the standards of care and codes of practice to which providers are held accountable.
The cost of proper education and training, or worse, the lack of training, has a major financial impact on the real cost and benefit of the technology being evaluated. The cost and amount of training needs to be addressed early in the product evaluation process. Depending on the technology being acquired the true expense of the training can often be greater than the device itself. Many times members of the dental team rather than the dentist are the ones introducing patients to the systems being used in the practice and who most commonly use the equipment, yet these individuals may have received little or no formal training. It has been estimated that dental practices benefit from or utilize less than half of the features that most technologies have to offer the practice. Again, this under-utilization is due primarily to the team’s lack of knowledge and training. In turn, the efficiency and productivity of the practice is adversely impacted. Thorough and comprehensive training can provide the greatest return on investment over anything else on which the practice spends money.
To understand the real cost of the proper training and education needed there are several factors to consider:
What Does the Team Already Know?
First is the dental team’s present knowledge of the type of technology being evaluated. If this is more than just an upgrade to a technology that is currently being used in the practice then the team will need to be educated on the basics of the new technology and the value, procedures, or processes it will provide. This will help in selecting the specific device that is best for the practice. Whether the new system will work well with the practice’s existing systems must be considered. Additional training that is not directly related to the new technology may be required. These training costs must be added into the equation. This educational step can be easily overlooked and result in a significant financial consequence to the practice that could have been avoided.
Who Will Do What?
The next consideration is determining who can perform what functions and what training is required to perform them. As mentioned earlier, the amount of training needed to efficiently derive the greatest benefit from a new system is often underestimated in the sales process. A related consideration is the level that each staff member will need to be trained in order to be in compliance. Also, any additional training that may be recommended for each member of the dental team is a factor. Such additional knowledge gained may be of great benefit to both patients and the practice.
Where Will the Training Take Place?
Another consideration in the real cost of training is where and when it is being held. Does it require the practice to be completely shut down for a period of time? If so, what is that cost in lost revenue? Sometimes the least productive training is that which is performed in the dental practice itself—even with the office being closed there can be frequent interruptions and distractions that disrupt the training process. The cost of travel, if required, and supplies needs to be taken into account.
The number of attendees in the training class must also be considered. Training sessions in small groups from multiple practices outside of the office tend to be the most beneficial. A small group environment stimulates interaction and questions from other offices and may provide a perspective that can be valuable in developing a practice’s specific protocol for implementation. For courses with a hands-on component, the ADA-CERP (American Dental Association-Continuing Education Recognition Program) and AGD-PACE (Academy of General Dentistry-Program Approval for Continuing Education) guidelines require an attendee-to-faculty ratio of no more than 15:1 to help ensure a quality experience and adequate guidance.
Will Ongoing Support Be Needed?
The ability to acquire and have ongoing training and support is essential, and this cost needs to be budgeted into the cost of the technology as it is being acquired. As staff changes occur, pathways for new and existing staff members’ education and training must also be addressed and established to ensure a smooth transition. Additionally, if it is anticipated that the technology will require ongoing enhancements, an understanding of how they are going to be supplied and implemented, the training that will be needed, and the related costs involved will need to be considered. This means the stability of the product manufacturer and its educational commitment need to be considered when acquiring technology.
Are Added Costs Involved?
Lastly, the cost or tuition for the training needs to be determined. Is training included in the purchase price of the technology? Is there a limit to the number of participants that can attend per office or per device? Is there an additional cost for another dentist, or hygienists, clinical auxiliaries, and administrative staff?
Having the proper technology plan that includes a comprehensive and ongoing education and training program for the entire dental team is essential for the successful implementation of any new system or technology. The goal is to provide the highest quality care possible in the safest and most efficient way possible for both patient and the practice. A thoroughly trained team is the key component in reducing the stress and anxiety of incorporating a new technology and attaining the best outcomes.
1. American National Standards Institute. American National Standard for Safe Use of Lasers in Health Care. Orlando, FL: Laser Institute of America; 2011. ANSI Z136.3-2011.
2. Informatics: Standards, Technical Specifications and Technical Reports. American Dental Association website. http://www.ada.org/en/science-research/dental-standards/standards-committee-on-dental-informatics/standards-technical-specifications-and-technical-reports. Accessed October 22, 2014.
About the Author
Scott D. Benjamin, DDS
President, Academy of Laser Dentistry
Sidney, New York