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Navigating Post-Graduate Education
Allison M. DiMatteo
A Look at Learning & Education Opportunities in Dentistry
To remain up-to-date with their practical skills and clinical knowledge, dentists must pursue continuing education to meet state requirements, as well as satisfy their elective interests. They can choose to attend education programs offered at dental schools, organized dental meetings, and a host of private institutes. How objective and valid is the information that’s being presented? How forthright are the advanced descriptions of the courses being offered in terms of describing what’s to be discussed/learned, introducing who’s conducting the instruction, and disclosing who’s sponsoring it? In other words, how do attendees know who’s behind the podium?
“When someone is lecturing or speaking, you really can’t evaluate if it’s fact or fiction, but you have to base your judgments on what you hear and on the reputation of the person speaking,” says Gordon J. Christensen, DDS, MSD, PhD, founder and director of Practical Clinical Courses, co-founder of Clinical Research Associates (now CLINICIANS REPORT), and dean of the Scottsdale Center for Dentistry. “When somebody that’s working for the company stands up and talks about bleaching, I’m going to listen, and then I’ll filter what I’ve heard through the experts to make the judgment. It depends on the commercial relationship.”
It used to be enough for dentists to rely on trusted sources like the Academy of General Dentistry Program Approval for Continuing Education (AGD PACE) or the American Dental Association Continuing Education Recognition Program (ADA CERP), which have established guidelines to help ensure that continuing education content is scientifically sound and not biased, stresses Mark Malterud, DDS, MAGD, president of the Minnesota AGD. Both review the administrative processes to ensure that the provider is set up to offer quality education. Providers are required to have procedures in place to ensure that scientifically sound courses are provided without undo commercial bias. However, Malterud admits that even he’s noticed that with some of these programs, even with guidelines in place, there are a few that participate that don’t really follow the rules.
“The main question in postgraduate education is where does a dentist, dental specialist, or dental staff member obtain this education? There are several fine postgraduate dental education groups providing excellent education for the profession. Some of them have been around for many years and have proven themselves as legitimate, ethical organizations,” Christensen has observed. “On the other hand, some postgraduate dental education organizations have come into the profession with great flurry, expectations, and plans, only to fall into significant commercial involvement and eventual lack of trust and acceptance by the profession. Additionally, some postgraduate groups are providing education on only specific aspects of the profession.”
Trust is the key word when it comes to attending courses for advanced or continuing education, believes Richard J. Simonsen, DDS, MS, dean of Midwestern University College of Dental Medicine. Anyone attending a course must know who the people involved are. Although this takes time, he says, dental professionals should develop a level of trust with both the individual lecturer and the institution providing the course.
“There are many institutes or centers out there, and it’s really not that difficult to see which ones are dedicated to professional improvement and which are dedicated mainly to commercial and financial interests,” Simonsen says. “I think it’s up to the individual practitioner to decide what it is that he or she wants from a program, and then learn by experience and asking around where they can go and who is trustworthy in delivering this information. Those unaccredited institutes that consistently use academic nomenclature such as ‘accredited, graduate, alumni, faculty’ and other terms are trying, through selective use of language, to make the public think that dentists taking their courses have attended a university postgraduate course of study.”
This month, Inside Dentistry attempts to make readers more aware of who is driving the education programs they may attend, as well as more conscientious about looking for potential bias in the advanced learning opportunities they undertake. Additionally, this feature encourages readers to scrutinize more carefully the credentials of the speakers they’re listening to and/or trusting to help them enhance their skills and knowledge. We also revisit the topic of disclosure as it relates to the information presented in educational settings.
Admittedly, the list of potential interviewees for this presentation could have been far more extensive. However, it sufficed to go to the heart of the matter by speaking with those who’ve established a foothold in the dental industry based on their continued observation of and participation in the delivery of learning opportunities for dental professionals. Their examples demonstrate what might take place behind the podium in order to deliver dental background, material, and technique information in today’s education environments.
Accreditation & Certification 101
The providers and organizers of continuing education programs are approved to do so by either AGD PACE, ADA CERP, or both, demonstrating that they adhere to specific guidelines and requirements for objectivity and learning expectations. In some instances, they may not be approved or recognized by any overriding authority of any kind. A list of ADA CERP providers is available at www.ada.org in the pages related to Continuing Education. A list of AGD PACE providers is available at www.agd.org/education/pace.
“There is no one governing these kinds of courses. For continuing education in the broadest sense, the ADA CERP program and the AGD PACE program offer recognition or approval of program providers,” explains Laura M. Neumann, DDS, MPH, senior vice president of the ADA’s division of education/professional affairs. “Those are voluntary programs, so I think it would be a stretch that there is any kind of governance.”
Every dental school is accredited by the Commission on Dental Accreditation, and that commission evaluates the curriculum of the school, Simonsen explains. From that curriculum comes much of the information that is taught in continuing education courses. For individual courses, it would be the responsibility of perhaps the director of continuing education at the dental school, he says, to ensure that they are in fact in accordance with those requirements and that all courses under the university sponsorship banner are evidence-based and meet the necessary professional criteria for appropriate teaching.
Neumann clarifies two points of confusing terminology used throughout dentistry: accreditation and certification. Accreditation is a process whereby an organization or a group sets standards for other organizations and evaluates their ability to comply with those standards, she says. For example, organizations that provide continuing education are approved or recognized (ie, accredited) for these activities because they comply with certain guidelines. Certification is a process for evaluating individuals and certifying their competency or their ability to meet certain criteria (eg, a fellowship or mastership program), she adds.
Who’s Teaching & Shaping The Curricula?
Simonsen notes that his school’s program is clinically based and, therefore, they look for a strong clinical background in their faculty, as well as the usual track record in research, something that would be measured in terms of publications and peer-reviewed journals and service. Teaching experience at another school is also a positive sign of an applicant’s experience, he says.
“One particular area of concern I have is that I see certain institutes teaching what I would regard as graduate-level specialty subjects (eg, prosthodontics, endodontics, periodontics), but they’re using general practitioners as the teachers,” Simonsen says. “I think it is very hard to train people or attempt to train them at a higher level than one has been educated. In my opinion, a specialist area, such as full-mouth reconstruction, should be taught by specialists.”
At the University of Texas Health Science Center at San Antonio, Dental School, a combination of faculty from the school and outside presenters provide instruction during continuing education programs, explains William O. Butler, MS, director of continuing dental education. That combination fulfills two objectives, he says. First, the dental student who has graduated from San Antonio probably has heard the faculty enough times that they would like to hear somebody else lecture on the same subject matter. Secondly, there is probably a good chance that the lecturer reinforces exactly what the faculty taught the student while they were there, which raises the level of respect that the graduate has for the school’s own faculty, he says. Approximately 60% of the school’s speakers are faculty, 40% are outside lecturers.
“Before I invite outside speakers to present a program, I would have to have heard that speaker at least three times,” Butler explains. “There also are different criteria that I’m looking for as I evaluate that speaker to ensure that they’re appropriate. From there, we do background research to be sure that the individual is qualified to present on a specific subject matter.”
In terms of curricula, Butler says that each dental school probably has its own strengths, so it would be logical that a school would try to focus its continuing education on the expertise it has. However, there is also the recognition that many dentists have great loyalties to their dental schools first, he admits, and they probably look to other dental schools and other activities second for continuing their life-long learning.
“You’ll see a lot of short courses come out of dental schools that are one or two days in length,” Butler observes. “What we’ve done at UTHSC is try to do one- or two-day courses and even three-hour courses, but also develop more continuum-type programs (eg, implant or esthetic continuums). However, those are hard to conduct without the benefit of a commercial entity to help market them.”
According to Joan Forrest, president of the Dawson Academy, faculty at the Academy are evaluated based on their clinical outcomes, education, and teaching ability. Further, all of the faculty must demonstrate a “teacher’s heart,” which means a passion for the profession and a desire to share what they have learned. Good teachers are driven by a desire to meet the student’s needs, not to meet their own ego needs, she adds.
“Glenn DuPont, DDS, is the Dawson Academy’s director of faculty and is responsible for instructor evaluations, both prior to joining the faculty and while maintaining faculty status. The continuous evaluation process ensures that we teach what we do, and do what we teach,” Forrest explains. “We conduct a pre-course and post-course evaluation to determine the effectiveness of the course objectives, and a curriculum committee reviews course evaluations and student surveys to modify or enhance curriculum based on students’ needs.”
At the Las Vegas Institute for Advanced Dental Studies, its clinical instructors must complete its Core Curriculum and several adjunct courses as well, explains William G. Dickerson, the founder and CEO of LVI. Most of them have been to more than 15 courses at LVI. These instructors first apply for the position with a detailed explanation of why they want to be an instructor, after which they are placed among the list of applicants and, when there is an opening, LVI staff will determine who would best fill that position, he says. When someone is chosen to instruct, they shadow an existing instructor for a program. They then basically have a working evaluation for the next program they instruct to determine if they are right for the position.
“We look for excellent dentists who are not only knowledgeable, but individuals who are down to earth and want to share their wisdom. We avoid hiring arrogant instructors,” Dickerson emphasizes.
LVI is an AGD PACE approved provider. Each LVI course is extensively evaluated by LVI attendees, and every evaluation is read thoroughly, Dickerson explains. LVI evaluates every program to determine how to better get the information to students for optimal learning, and instructor meetings are conducted to encourage faculty input on ways to improve LVI programs, Dickerson says.
Instructors at the Pankey Institute are selected by the resident faculty, and final approval is granted by Steve Ratcliff, DDS, the chairman of the department of education. Typically, Pankey instructors are individuals who have completed the Institute’s curriculum, so Ratcliff and the other faculty have seen their work over a multi-year period and developed an understanding of what they’re doing, he says.
“We have a faculty development program called ‘Facilitators in Training’ in which we have a chance to work with young people whom we believe have the talent to facilitate learning in others, as well as the clinical and behavioral talent to do well in dentistry,” Ratcliff explains. “That process started two years ago, where we have chosen mostly younger dental professionals (eg, under the age of 40) who show this promise and invite them to participate in meetings once or twice a year.”
These meetings involve teaching, specific kinds of education, and an opportunity for a peer-review of their own dentistry. Over time, Ratcliff says he and the other faculty get to know these future instructors fairly well in order to determine what their talents and capacities are, as well as how they interact in their respective communities.
The Pankey Institute curricula is monitored and evaluated by the Curriculum Committee that assists the Education Department, Ratcliff says, and is comprised of some faculty members, some active participants, and some members of the Board of Directors. Courses are evaluated on a weekly basis, and resident faculty meet weekly to discuss curriculum direction and the long-term vision of the Institute.
“Faculty members attend outside continuing education courses, also,” Ratcliff says, “to keep their ears to the ground and listen to the pulse of what’s happening in dentistry and because we believe that there are many other places for dentists to gain exceptional learning experiences. We know we are not the last word.”
The Scottsdale Center for Dentistry has been under the leadership of Christensen for nearly one year, and the mission statement of the Center drives decisions regarding faculty and curriculum devel-opment, he says. The Center’s mission is to increase the basic science knowledge, clinical skills, practice enjoyment, self-esteem, and financial productivity of all participants by providing high-quality, pragmatic, ethical, evidence-based, affordable, colleague-centered, and patient-oriented continuing education for all disciplines within the dental profession, Christensen elaborates.
“Our goal is to provide continuing education on all areas of dentistry and to all levels of dentists and staff members. In my opinion, that is a major lack in dental postgraduate education today,” Christensen believes. “The Scottsdale Center for Dentistry has 25 departments, including all areas of dentistry, with carefully selected department directors meeting specific selection criteria. Our profession is a health profession. In my opinion, it does not have responsibility for just the affluent, just those who can afford so-called rehabilitations. It has responsibility for all educational levels of patients from all walks of life, with all levels of income.”
Faculty at the Scottsdale Center for Dentistry must demonstrate an excellent teaching ability, up-to-date knowledge of his/her specialty/area, a reputation for providing pragmatic, easily applied information, and known clinical expertise or expertise in his/her respective non-clinical area, Christensen explains. Further, the individuals selected to instruct at the Center must have no commercial (ie, conflicting) interests, be honest, have demonstrated previous or current financial success as a clinician in his/her respective income area, and exhibited maturity in the teaching arena, he says.
The Center’s curriculum is designed such that at the completion of any course or series of courses, participants should be able to accomplish any number of general tasks specifically outlined in the program objectives. However, each course has its own specific and detailed behavioral objectives, Christensen clarifies. Possible objectives may include: discussing with faculty, course participants, their own staff, and other dentists the major components of the course and their potential value when implemented into dental practice; deciding which of the components of the course would best be implemented into their own practice or other dental activity; and planning and administering in-service education sessions in the home office to educate all persons involved concerning upcoming implementation of course components into practice, among others, he says.
Disclosing Interests & Financial/Product Support
According to Simonsen, it is extremely important that sponsorship and support be disclosed, both in the written advertisements for a program and verbally to the audience during the introduction of speakers/instructors. The key is that the audience has the information they require for appropriate judgment of the information they’re being given, he says.
“There is nothing, per se, unethical with commercial support for an educational program as long as the audience is fully aware of the extent of the potential for bias that is created by such support,” Simonsen emphasizes.
Butler says that the University of Texas Health Science Center at San Antonio, Dental School, does very well with working relationships with companies. They do receive support from manufacturers, disclosing the relationship and ensuring that the information is made available to course participants and students. This is accomplished in several different ways that are consistent with ADA CERP and AGD PACE guidelines, Butler adds.
At the Dawson Academy, each faculty member is required to complete a conflict of interest form, and any sponsorship also must be declared from the podium, says Forrest. She adds that the Academy currently does not receive any financial support from sponsorships. The 3M Company has funded tuition scholarships to support dental residents desiring to take courses at the Academy.
LVI does not have exclusive support from any manufacturer. Rather, it makes use of products from almost every manufacturer, even if they are not a sponsor, Dickerson says. Most of the sponsorships LVI has are in the form of scholarships for attendees, and the sponsoring companies are disclosed in every manual and highlighted on the walls of LVI, he says.
Any materials or technology used at the Pankey Institute for its courses are paid for by the Institute, Ratcliff says, and any resident or visiting faculty are required to provide full disclosure of any manufacturer sponsorship relationships that they have. He also notes that any resident faculty also make full disclosure any time they speak outside of the Institute, so if there is a potential conflict of interest, it is out in the open. Ratcliff did indicate that the November 2008 “Gathering of Eagles” international symposia at the Institute—which would require a large scale budget—would have manufacturer support that would be disclosed during the event, as well as in its marketing literature.
Programs at annual meetings—such as those conducted at the AGD PACE and ADA CERP approved scientific sessions of the American Academy of Cosmetic Dentistry (AACD) annual sessions—must also fully disclose any affiliations, conflicts, financial interests, or sponsorships involving manufacturers. According to Laura Kelly, accredited technician and president of the AACD, every one of the AACD’s course descriptions in its annual scientific session guide includes a clear statement after each particular speaker indicating whether or not there are any sponsorships or conflict disclosures. It’s mandatory, she says, for each speaker to complete their speaker agreements and disclose any relationships that they have with manufacturers.
“We value the manufacturers that support us because they are providing the new technology and products that are entering the profession,” Kelly says. “There’s nothing wrong with a supportive relationship as long as it’s disclosed, and it really is a partnership that benefits dentists, technicians, manufacturers, and the consumers.”
Certifying Program Completion—What Does It Mean?
The Dawson Academy does not currently offer any type of accreditation/certification status to its course participants, in compliance with its ADA CERP and AGD PACE status, Forrest says.
LVI also does not have or offer an accreditation or certification status, explains Dickerson. The only LVI program that approaches that is its “Core Curriculum,” which is comprised of seven clinical courses. “We do have an LVI Mastership that an LVI graduate can strive toward, which requires that they also complete other courses,” explains Dickerson. “That Mastership comprises an intense but specific test of the materials learned and submission of three full-mouth reconstruction cases that are then thoroughly evaluated by our faculty, making sure that all the criteria have been properly incorporated (eg, bite maintenance, occlusal principles). It’s not just an esthetic evaluation.”
At the Pankey Institute, which carries both ADA CERP and AGD PACE designations for continuing education, course participants do not receive certification/accreditation, explains Ratcliff, but they can be granted the distinction of Pankey Scholar upon completion of a designated course of study that includes the Pankey “Continuum” of the recent past and the new Essentials program, as well as other courses both inside and outside of the Institute. The Pankey Scholar program, Ratcliff says, consists of two meetings completed over a year’s time. Throughout the process, participants share what they’ve learned in all aspects of what the Pankey Institute teaches, whether technical, behavioral, philosophical, managerial, or financial.
“There are specific requirements for the process in terms of cases, with participants having to show three cases that demonstrate their understanding of how they developed their technical skills, their staff and their patients, how they worked with specialists and their laboratory, and how they created systems within their practice,” Ratcliff explains. There are other components of the process, including faculty review of the progress after the two courses and completion of assignments made during the process. “The faculty meets and if they make the assessment that that individual has completed all of the assignments and fulfilled all of the parameters outlined in the process, then they are granted the designation of Pankey Scholar.”
The AACD’s accreditation processes—one for laboratory technicians and one for dentists1—are testing protocols specifically for the cosmetic dentistry profession, explains Kelly. Accreditation is a three-part process consisting of a written examination, submission of clinical cases and reports for evaluation, and an oral examination. Each part must be completed in sequence. The candidate has flexibility to proceed at a pace that works best for the individual, as long as the process is completed by the fifth annual scientific session after passing the written examination. All phases of all cases must be passed successfully to receive accreditation status, Kelly says.
Knowing Who’s Who & What’s What
When it comes to scrutinizing the continuing education program itself, Neumann advocates looking to see that a continuing education provider operates under principles of quality education, as well as good practices for administering their program in a responsible, ethical, and accountable way.
To determine if a continuing education provider is operating in this manner, Neumann suggests considering the organization’s publicity (ie, is it objective information that provides an accurate description of the objectives of the course, who the faculty are, and what the teaching methodology is?). She also says to look at the organization’s mission statement (ie, is their mission education or a commercial interest?). Finally, the course objectives should very clearly and specifically outline what the attendee will learn and be able to do upon completion of the course.
Neumann indicates that there is an organization called the National Organization for Competency Assurance that accredits certifying organizations. It’s not used much in mainstream dentistry, although it is a reputable organization that has been used by other disciplines and professions.
“If a group that is conducting either certification or accreditation is not accountable to anyone, then there is always some question about the validity of their process, because the potential for bias is there when there is no external check and balance or verification that they have an objective process,” Neumann says. “In dentistry, I think we have a range, and there are some really good certification processes that make an attempt to do a credible job of whatever it is that they’re doing; then there are probably others that just meet their own needs.”
Overall, Ratcliff believes that many instructors and educators in dentistry are doing “a good job” in terms of self-monitoring themselves. He notes that aside from ADA CERP and AGD PACE, there isn’t an approval process for what different organizations or institutes have to offer.
Malterud cautions that when selecting continuing education opportunities, if the educators and course outline sound too good to be true, it’s probably going to be heavy on the “fluff” and possibly lean toward more of a sales pitch. Therefore, dentists need to have a base of sound educational experiences that will allow them to make proper decisions about what could be good, bad, or ugly in dental education.
According to Christensen, postgraduate dental education is a necessity for all ages and abilities of dentists and dental staff personnel. There is far too much to teach and to learn at the predoctoral level, and the constant increase in new information is astounding, he says.
“With technology, equipment, materials, and even the techniques changing so rapidly, if dentists aren’t taking continuing education from the day they graduate, they’ll start to fall behind,” Malterud observes. “Consequently, it’s tougher for them to distinguish what is good education and what is bad education. The more that you know, the easier it is to identify fact from fiction and good from bad. So, you need to stay on top of the education.”
Learn What You Want & Need, How & Where You Like
With the multitude of dental education opportunities to choose from, clinicians can select when and where they obtain their required and elective learning based on their needs and preferences. Determining their needs is not always a scientific process, explains Linda Niessen, DMD, vice president and chief clinical officer for DENTSPLY International and clinical professor in the department of restorative sciences at Baylor College of Dentistry. Rather, it’s a process that often starts with an internal needs assessment and asking such questions as, “What do I need to learn (eg, practice management, new clinical techniques, endodontics, implants, restorative therapies)?”
The next steps involve talking to peers and determining where to go based on who’s doing and teaching what. That’s why knowing who’s behind the podium is so important. “You may ask specialists in your area for their recommendations, or you may talk to a faculty member, another colleague, or a study group that you participate in,” Niessen suggests. “Then it’s a matter of finding out who the experts are and where they’re located.”
In this regard, Mark Malterud, DDS, president of the Minnesota Academy of General Dentistry, is a firm believer in the mentoring process. He does believe that dentists should use their own judgment when selecting courses, but he says the help of mentors for young and seasoned professionals alike is invaluable.
“Over the last 25 years of practicing, I’ve developed a list of mentors that I’ve followed, and they’ve helped me in choosing the courses that I should take, which has subsequently helped guide the course of my practice,” Malterud admits. “These mentors are a really good resource to find out if a group is ethical or the education is valid, because they’re in the know and on the inside of many of the circles where this knowledge is actually learned and cultivated.”
For a time, dental professionals could be fairly confident that if a continuing education program were conducted at a dental school that it would be well-rounded and less likely to be affected by commercial interests, observes Richard J. Simonsen, DDS, MS, dean of Midwestern University College of Dental Medicine. “I think this is changing, however, and I guess the only thing one can really rely on is that appropriate disclosure is made of commercial interests to all course takers before and during the programs.”
When evaluating courses and programs, our interviewees suggest it’s important to look for those offered and conducted by providers that carry approval from ADA CERP or AGD PACE. Such education opportunities will likely have met specific criteria for learning objectives, not merely be a sales pitch. Then dental professionals can choose from possible program locations, which may include the following.
1. Dental Schools. Sonny Serreno from Heraeus Kulzer believes that dental schools provide an interesting opportunity for continued learning because they typically provide access to fully equipped simulation laboratories for hands-on programs, which can be extraordinarily effective. “Doctors are very tactile, and they like to feel, touch, and see things, and I think simulation laboratories are a very good thing,” Serreno says. “However, sometimes the individuals teaching those courses may not practice full-time in the real world, so they can’t offer the same perspective as someone who’s actually running their practice every day.”
According to Niessen, dental schools do offer a built-in clinical facility for learning, so laboratory-based learning using models or simulators is facilitated. If dental schools make their simulation laboratories available for continuing education courses, they clearly could differentiate themselves in that respect, Niessen says. Additionally, because of its school/on-site clinic setting, dental schools provide the opportunity for out-of-state practitioners to work with live patients during continuing education programs, providing all consents/protocol have been followed, she says.
“Dental professionals—dentists, hygienists, assistants, and laboratory technicians—should think about their dental school as their safe home for life-long learning. It’s where they got their start, and it’s where they can go back for continued learning,” Niessen emphasizes. “The schools recognize that they’re teaching you the basic fundamentals in those first four years, but that you’re going to be practicing for 30 or 40 years; the technology and the science are going to change. The faculty are teachers first and foremost. They want to help you and answer your questions.”
Laura Neumann, DDS, MPH, the ADA’s division of education and professional affairs senior vice president, comments that when dental schools offer continuing education, they tend to use their own dental faculty—people who not only have a dental degree and are recognized by their peers as being leaders in their field, but who, many times, have advanced education and undergone a tenure review process at their institution. “They have a track record of scholarly activity and research that has been reviewed by peers, and there is a pretty good assurance that their instruction is based on not only sound science, but also a high level of expertise in the field,” Neumann asserts. “Dental faculty courses also tend to be very much in-depth.”
2. Private Institutes. These are ideal for long-term learning relationships, Serreno says, and there are many out there to choose from that can take the dental professional from beginning to advanced levels in a specific area of interest. “Private institutes have a lot to offer, and they look to establish on-going, meaningful relationships with their attendees,” he observes. “On the down side, these may be limited to a specific philosophy depending on whom that private institute is mentored or founded by.”
3. Annual Meetings. Annual meetings offer the benefit of providing access to courses on a large variety of topics, Serreno says. They represent a tremendous opportunity to see whatever clinicians want to see and learn about whatever they’re interested in. The courses or lectures are typically conducted by leading opinion leaders in the industry, he says, and it’s usually on the latest and most innovative technologies. “These are usually highly monitored, so they can’t be a sales pitch,” Serreno observes. “However, the drawback to courses at annual meetings is that you’re limited in the amount of time that you have in a lecture or a hands-on course because there are so many things going on. It can be a very brief learning experience.”
At the American Academy of Cosmetic Dentistry (AACD) annual scientific session, there are many hands-on workshops that are conducted, all of which are made possible by corporate sponsorship, explains Laura Kelly, accredited technician and president of the AACD. She notes that the sponsorship is fully disclosed, as well as the nature of which products and types of techniques will be demonstrated and taught and what the participants will learn.
4. Corporately Sponsored Programs. Manufacturers lead the dental industry in bringing new technology and advancements to the profession, spending millions of dollars on research and education, Serreno says. Courses sponsored by dental product manufacturers should not simply be mere “infomercials,” but rather sessions designed to teach and instruct, and they should be ADA CERP or AGD PACE approved so that participants know it’s not a sales pitch. “Education would stop, it would cease, if corporations did not sponsor events,” Serreno believes. “Financial support from manufacturers is necessary to provide quality education at a reasonable cost, otherwise most professionals couldn’t afford to go, and most speakers couldn’t afford the time away from their families and practices.”
These examples fall along the lines of the more active types of continuing education on what Niessen refers to as the “continuum of life-long learning.” This continuum begins with passive continuing education in the comfort of an individual’s own home (eg, print- or Web-based self-study) and progresses to more interactive self-study at home (eg, interactive Webcast). Active learning entails classroom attendance and hands-on, laboratory, or live patient participation. The ultimate learning, Niessen says, is teaching someone.
“It’s see one, do one, teach one, and to the extent that you are engaged, you retain more information,” Niessen explains. “The pedagogical or teaching literature says that adults learn by doing. To the extent that you involve them with the hands-on course or with teaching a course, they will retain more of the information. The true way to retain 95% of your information is to ask someone to teach the course, and they will learn the material very well.”
According to Malterud, those education formats that provide a nonbiased, scientifically based learning experience with a great deal of hands-on time are probably the easiest way to describe the most appropriate postgraduate coursework. A significant number of dentists learn by handling materials and equipment, he says. Consequently, these hands-on portions allow them to learn at a higher level, he says.
“I really emphasize the nonbiased aspect of it,” Malterud says. “We should be educated on the science, not on a marketing ploy from a company.”
Show Me the Money…And Where It Comes From
Are sponsorships of learning and education opportunities in dentistry necessary? As representatives of any dental school or postgraduate facility will tell you, putting on extensive hands-on programs such as those conducted at private institutes, annual meetings, or at the dental schools themselves is very expensive.
According to Linda Niessen, DMD, from DENTSPLY International, new technology is continuously entering the dental practice, bringing with it ancillary new materials and accessories that weren’t taught or used in dental school. The manufacturers, she says, have the scientists who understand this technology and can communicate it to the profession.
“To the extent that dental professionals understand the technology and the science behind new products, they will use these products and devices better. They’ll use them appropriately,” Niessen believes. “Manufacturer research and development is driving the continuing education because you need the continuing education as a means to communicate this new science and technology.”
In this regard, she says manufacturers have a wonderful role to play as partners with dental schools, clinicians, study clubs, and others to help dental professionals achieve their life-long learning needs. However, whatever the nature of the support, all conflicts of interest or potential conflicts of interest should be disclosed.
“The ADA CERP and AGD PACE require it. FDA guidelines on continuing education require it, and respect for your audience demands it,” Niessen emphasizes. “DENTSPLY complies with the ADA CERP conflict of interest guidelines, and we request that any speaker that we would sponsor disclose to the audience that DENTSPLY is sponsoring their continuing education course. When we sponsor speakers through universities (eg, an educational grant to support a program) or meetings, we request them to disclose it, also. We want the audience to know.”
The Academy of General Dentistry is a PACE provider, also, explains the Minnesota AGD’s Mark Malterud, DDS. Therefore, it too must adhere to PACE standards like any other continuing education organization. Those standards include disclosing any and all sponsorships and conflicts of interest in all marketing materials and at the beginning of the course, he says.
“The dentists know going into a PACE program if someone is being paid to be lecturing in a course. It is in the marketing materials so that when the dentists are reviewing it, they can determine if the program is marketing hype from company A or whatever,” Malterud says. “They might either choose to attend it or not choose to attend it. They’re also reminded at the beginning of the program that it is being sponsored by somebody.”
Laura Neumann, DDS, MPH, from the ADA’s division of education and professional affairs, notes that if there is a commercial provider or sponsor, some kind of statement about either disclosure of the conflict or the other interests of the provider is necessary. Attendees should be able to see how those conflicts are managed so that they don’t interfere with the quality of education, so it’s not biased, and so the dentist can have a lot of confidence that what he or she is learning is objective information based on sound science, she says.
According to Sonny Serreno, director of product development for Heraeus Kulzer, dental product manufacturers spend enormous amounts of money sponsoring education and learning events, whether they’re through study clubs, dental schools, private institutes, annual meetings, or Podcasts. In his own experience, he believes that organizations and speakers alike are doing well in their efforts to disclose the support of manufacturers, whether that involves including logos from sponsoring companies, mentioning the support at the beginning of their programs, or noting the fact in their program guides prior to or during the event. There are exceptions, Serreno admits, but he says those instances are fairly obvious when they occur, and they’re exceptions.
“I think it’s in the best interest of the professional base to have corporate-sponsored education programs, even if they’re about a specific product, as long as they’re approved,” Serreno says, noting that all of his company’s sponsored education programs are ADA CERP or AGD PACE approved. “It provides manufacturers with the opportunity to give specific scientific information about a material or technique to the profession that dentists probably would not get unless it was sponsored by the manufacturer. You might get a feature or a benefit, but you may not get the in-depth explanation of how and why chemistry or technology has developed.”
Laura Kelly, president of the American Academy of Cosmetic Dentistry, notes that there is strong manufacturer’s support at the AACD’s annual scientific sessions. “Since the AACD is a non-profit organization, it can be cost prohibitive to bring in the equipment, the instructors, and the different materials that are required to conduct the restorative or laboratory procedures,” she says.
The inside look from
All of us at Inside Dentistry strive to deliver clear, objective, and relevant reporting of the issues that face the general oral healthcare profession. The publishers and staff gratefully acknowledge the following individuals, without whom this Inside look at the variety of learning and education opportunities for the dental profession would not have been possible. Their candid comments and professional insights were invaluable to developing a comprehensive and timely presentation.
William O. Butler, MS
Continuing Dental Education
University of Texas Health
Science Center, Dental School
Gordon J. Christensen, DDS, MSD, PhD
Co-Founder, Clinical Research Associates (now CLINICIANS REPORT)
Founder & Director,
Practical Clinical Courses
Dean, Scottsdale Center for Dentistry
William G. Dickerson, DDS
Founder & CEO
Las Vegas Institute for Advanced Dental Studies
Dawson Center for Advanced Dental Studies
Accredited AACD Technician
American Academy of Cosmetic Dentistry
Mark Malterud, DDS, MAGD
President, Minnesota Academy of
Member, Academy of General Dentistry Dental Education Council
Laura M. Neumann, DDS, MPH
Senior Vice President
Division of Education and Professional Affairs
American Dental Association
Linda Niessen, DMD
Vice President, Chief Clinical Officer
Clinical Professor, Department of
Baylor College of Dentistry
Steve Ratcliff, DDS, MS
Chairman, Department of Education
The Pankey Institute
Richard J. Simonsen, DDS, MS
Midwestern University College of