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Reaching New Heights
Dentistry’s top educators emphasize commitment to lifelong learning
By Allison M. DiMatteo, BA, MPS
Inside Dentistry spoke to several of dentistry’s top educators to glean their thoughts on how and why their institutes provide value in continued learning for general practitioners, the areas in which today’s new dentists are the most unprepared to practice, how dental education has changed over the last 20 years, and where they think it’s headed.
Graduation from dental school is not the completion of a new professional’s education, but rather the beginning of a lifelong journey toward skills development and applicable knowledge cultivation. While dental school provides a solid foundation of basic knowledge, the rapidly increasing pace at which new technologies, techniques, and material advancements are affecting how dentistry is practiced make it imperative that postgraduate programs, continuing education institutes, and study clubs fill in the blanks.
In and Out of Dental School
In 2015, more than 5,800 students graduated from the 65 dental schools in the United States. As their curriculum came to an end and they faced their future, they prepared themselves for either private practice (50% of graduates), residency programs (33% of graduates), or military or federally qualified health centers. Of those entering practice, 15% indicated they’d be employed in a corporate-owned, DSO concept group practice. For the one-third of graduates entering residency programs (ie, an estimated 2,000 new dentists), there were ample opportunities in the nearly 3,000 first-year residency slots available, notes Richard W. Valachovic, DMD, MPH, president and CEO of the American Dental Education Association (ADEA).
Prior to graduation, ADEA surveyed senior dental students about the subjects in which they didn’t feel they received sufficient instruction. On the top of their list: practice management and implant dentistry, particularly if they were thinking about entering practice. They also cited wanting more exposure to orthodontics in order to do a better job diagnosing cases for referral.
“But as you know, there’s only so much time in the curriculum to teach these things,” Valachovic says. “What dental schools are doing is preparing students to be lifelong learners. The focus of the dental curriculum is no longer a gross memorization of facts, but rather teaching students how to use what they know now while constantly acquiring new knowledge to apply to their practice as they develop in their career.”
Three or four decades ago, graduating dentists were able to have a career based on the procedures they learned in dental school. While some new technologies were introduced (ie, implants), most dentists learned through continuing education.
“The students who are graduating today will still be practicing in 2065, and we know that the slope of change is increasing very rapidly, so we have to prepare students for a changing environment,” Valachovic says. “Graduates have to be prepared for a practice environment that is going to be more large group practices—as opposed to small, one- to two-person private practices—with salaried employment and a focus on interprofessional and collaborative care. So, we’re starting to educate our students in a way that develops their critical thinking and lifelong learning skills.”
Incorporating New Materials, Technologies, and Ways of Practicing
Both newly graduated dentists and those who are mid-career will find it nearly impossible to master new technologies, materials, and techniques without reliable and trustworthy continuing education. State mandates for required ongoing continuing education credits aside, ongoing learning has no schedule, so clinicians must pursue information continuously, advises John Kois, DMD, MSD, director and founder of the Kois Center.
“One can never predict when research will reveal information that changes our clinical protocols or critical thinking,” Kois says. “There isn’t a fixed interval that recommends continuing education be done a certain way.”
The best approach for dentists to learn and incorporate new or more specialized procedures is to begin by determining their interests, finding reputable continuing education programs, and taking the hands-on courses, says Gordon J. Christensen, DDS, MSD, PhD, ScD, founder and owner of Practical Clinical Courses. When it’s time to integrate the approach into practice, he advocates doing so at the end of the day, when there’s ample time available.
“Each Christmas I figure out what I don’t know this year, and then I take courses and finally implement it,” Christensen says. “By about the middle of the year, it’s a part of what I do.”
Sometimes it is a matter of simply mastering basic concepts.
“A dentist at any stage of practice could benefit from a thorough understanding of diagnosis and treatment planning that includes competence in occlusal treatment,” says Peter E. Dawson, DDS, founder of the Dawson Academy.
For many dentists and their teams, the new procedures, techniques, and materials may involve incorporating technologies that enable a digital workflow throughout the practice. In some areas of dentistry, such as implant treatments, a digital workflow is superior to the old non-digital, non-guided surgical approach, observes Frank Spear, DDS, MSD, founder and director of Spear Education. Regarding restorative dentistry or prosthetics, he sees a digital workflow as a faster and more efficient alternative to a conventional workflow for those who master the technology.
“The only way to master the digital workflow is to really commit to it, get training in it, and then use it, and make the investment in time to continue to go back to the next level course,” Spear says. “If you take a class and don’t use it regularly, it becomes incredibly frustrating to them because there is a learning curve.”
Contributing to the learning curve is the fact that most dentists don’t understand a complete digital workflow, explains Ricki Braswell, CAE, president and CEO of The Pankey Institute. A digital workflow could include, among other technologies, an intraoral scanner, digital radiographs, practice management software, patient and treatment planning software, and a 3D printing or milling unit. Therefore, unless dentists have the ability to invest in an entire system, Braswell advises incorporating technologies that can work with something else (ie, interoperable, open architecture).
However, just like assessing the reasons for incorporating a new procedure, integrating a digital workflow requires consideration of how related technologies will fit into the practice and why they’re desired. If dentists are having problems with their impressions or a difficult time communicating with their laboratory, or if they want a tool to help them communicate with their patients and colleagues better, then a digital workflow can be beneficial, Braswell says.
“I think in 5 years, many things that seem kind of space age right now will be mainstream,” says John C. Cranham, DDS, clinical director of the Dawson Academy.
Cranham suggests that dentists first take an assessment of how satisfied they are with their practice, what other things they’d like to learn about, and why, and then talk to colleagues with expertise in those procedures to find out where they went for education.
“The key question here is, ‘What is motivating them to increase the opportunities in the practice?’” Kois says. “If it’s just about the money, I think they’re moving in the wrong direction. Instead, general practitioners should move toward making themselves an expert in what excites them, rather than a dabbler in just the procedures.”
Applying these new skills and techniques in practice then increases that level of expertise.
“In dental school, we didn’t learn by sitting back and listening; we had to discuss what we were studying and take action to really integrate the new concepts and skills necessary to succeed in our profession,” says Michael Cohen, DDS, MSD, founder of the Seattle Study Club. “That reality doesn’t change when we graduate.”
Whether a recent dental school graduate or a dentist in the middle of a career, there are many reasons to pursue ongoing continuing education. Among them are mastering procedural skills, becoming proficient in using materials and techniques, and applying innovative technologies within the practice. Fortunately, there is a variety of established and reputable continuing education institutes, any one of which dentists may find are ideally matched to their unique perspectives, learning styles, and professional goals.
“Any doctor who is pursuing continuing education with any of the major institutes is really called from the heart, and those doctors should be praised for their efforts, wherever they choose to get their advanced education,” Braswell says. “I really applaud them, because they’re distinguishing themselves for the betterment of their patients.”
The Dawson Academy
390 4th St N, #200
Saint Petersburg, FL 33701
Phone: 727-823-7047 | Fax: 727-821-0482
The Dawson Academy provides dentists who have been practicing for a while, as well as newly graduated dentists, with a solid understanding of the fundamentals of occlusion, esthetics, and biologic success in the context of sound treatment-planning principles.
“Our motto describes our goal: ‘We make good dentists even better,’” says Peter E. Dawson, DDS, founder of the Dawson Academy. “If a dentist practices today without the knowledge and skill of occlusal equilibration, there is only one explanation: That dentist does not know what he/she does not know, but really needs to know. With the number of practicing dentists who now do know the importance of total masticatory system harmony, I am optimistic it will eventually become the norm—at least for dentists who value postgraduate education and take advantage of what it can offer.”
The Dawson Academy’s courses are aimed at enabling dentists to design stable occlusion so they can be successful in their day-to-day practice, whether they’re doing a fundamental crown-or-bridge, or beginning to tackle more complex esthetic or implant treatments, explains John C. Cranham, DDS, clinical director of the Dawson Academy.
“Once dentists begin working in a functionally predictable environment, dentistry becomes much more enjoyable and certainly profitable as well,” Cranham says. “A large segment of our student base is dentists who have been practicing for 15 to 20 years, who want to do more complex cases, and who have a patient base that requires it. Trying to do that without mastering these fundamental principles is exceedingly difficult.”
Cranham feels strongly that comprehensive cases require very astute clinicians to be able to examine the case and know all the data needed for restoring it esthetically and functionally. The Dawson Academy teaches dentists a specific protocol for what records they need to obtain, how to analyze them, the checklist for clearly visualizing the case, and how to execute the case.
“First and foremost we teach knowing what we are going to create, which is why the first step is visualizing three dimensionally in space where the teeth need to go esthetically and functionally,” Cranham says. “Then we can start thinking about the materials or techniques.”
Dentistry’s material and technique landscape is changing so rapidly, but it’s important to be aware of the procedural type of continuing education courses focused only on using certain materials when performing specific techniques, Cranham says. These often skip some of the most important aspects of treatment planning that make a case successful.
“Whether it’s placing implants or doing some of your own orthodontics, if you’re bringing a new procedure into your practice, then that’s going to take more intensive study,” Cranham says. “The reason I think doctors invest in our core curriculum is usually because they view it as a mini-residency, where they’ll be able to handle more complex-type cases in their practice.” Dawson says improving one’s practice in this way can lead to a higher quality of life overall.
“Our goal is to show dentists how to have a balance between work and family life that is difficult to achieve with a dysfunctional practice,” Dawson says. “Hearing how what we teach has changed their lives for the better is my greatest reward.
According to John Kois, DMD, MSD, director and founder of the Kois Center, the ultimate purpose of the Kois Center is to create world-class performers and contributors in the dental profession based on an understanding of fundamentals: periodontics, biomechanics, functional relationships, and facial relationships.
Kois believes that postgraduate dentists come to the Kois Center for three reasons. The first is course content; the courses are designed to create a graduate program for practicing dentists that is integrated and cohesive, rather than a combination of different courses. This content is created from an evidence-based approach and focused on risk management.
“The second reason is our culture and collaborative learning opportunities,” Kois says. “I think it’s important to have a safe environment where practitioners can discuss failures and their problems. We also have mentors and clinical instructors who work closely with students inside and outside the classroom and who have become a critical support network to answer questions, provide follow-up information, and help with implementation struggles in private practice.”
The third reason is to create a vision and move toward a platform of what is possible and what can legitimately differentiate their practice in ways that simultaneously benefit patients, the dentist-provider, and the practice as a business.
Kois sees several trends—and a variety of different reasons—affecting why dentists choose the Kois Center for their mid-career continuing education. At a certain point, many dentists come face-to-face with the reality of their situation and, as they search for answers, may be told to run faster, jump higher, add products, or fire staff, all of which are mechanistic tactics that do not address fundamental causes. The Kois Center, however, challenges them to step back and closely examine what they have created and why, as well as whether they want to continue that approach or modify/change how they think about dentistry.
“We know that if you’re not changing, the world will pass you by,” Kois says. “At the Kois Center, we help our members prepare for a world of dentistry that is changing at the speed of thought. But what is new is not necessarily better, so we empower them to become better critical thinkers and make wise decisions for themselves.”
There are major differences between dental schools and the Kois Center, he says, because the two are inherently very different. The role of dental schools is creating core competencies and entry-level skills. The Kois Center is an environment for creating continuous improvement for dentists already in practice. With changes occurring so rapidly in the profession, it’s hard for dental schools to keep up, Kois says.
“My concern is the increasing gap between evolving science and what actually happens at the interface between the practitioner and the patient in the chair,” Kois says. “To close the gap, we continue to improve our curriculum, which is now completely digital; add more hands-on opportunities; and involve committees in our infrastructure to constantly improve the delivery of our product.”
The Pankey Institute
One Crandon Boulevard
Key Biscayne, FL 33149
Phone: 305-428-5500 | Fax: 305-428-5567
Whether they’ve been in practice for years or have recently graduated, the not-for-profit Pankey Institute offers dentists—and dental technicians—continuing education focused on what president and CEO Ricki Braswell, CAE, calls the three Cs: clinical competence, rather than training to perform a particular technique; confidence, so dentists can perform the dentistry they’ve learned; and compensation in the context of comprehensive care, taking into consideration fee estimating and variable and fixed overhead expenses. By focusing on the basis of appropriate diagnostics for treatment planning complex cases, and supplementing clinical skills with personal and practice leadership and financial management skills, she says the Pankey Institute emphasizes the areas that ultimately produce the best outcomes for patients.
Among the reasons mid-career dentists come to the Pankey Institute is a desire to reignite their passion for the profession, which is why a main component of the philosophy taught at the Institute is how to maintain a work/life balance. The other reason is to expand their clinical skills and practice services, whether by adding dental sleep medicine, implants, or full-mouth rehabilitations. Therefore, each of the Institute’s 34 annual in-house courses, in addition to those conducted on the road, incorporates a hands-on didactic component to reinforce learning.
However, unlike the majority of available CE opportunities that are sponsored by either an equipment, technology, or material manufacturer and, therefore, focused on techniques specific to those products, Pankey Institute courses emphasize critical thinking skills, treatment planning, and sequencing cases.
This is important, especially for recently graduated dentists who don’t have a point of reference to understand why components of a comprehensive examination are significant to diagnostics and treatment planning, Braswell explains. Recent dental school graduates possess a foundation of knowledge, but their ability to actually apply what they’ve learned in practice is a different scenario, she adds.
“By focusing on the ‘why’ behind clinical decisions, we’re teaching recently graduated and mid-career dentists how to achieve the optimal outcome regardless of what bur, porcelain, or other material or equipment they use,” Braswell says. “Not every patient presents with the same needs, so if dentists are only taught to use certain products or techniques in specific ways, they won’t have another tool when what they’re using isn’t appropriate for a given case. The Pankey Institute teaches clinical skills that are independent of what material dentists choose to use, so they can be applied to a variety of different circumstances with their patients.”
However, Braswell does note that it is important to remain current with the increasingly rapid changes in material science, so dentists’ continuing education in this area should match the pace with which new materials are being introduced. For this reason, the Pankey Institute does teach indications, contraindications, and other consideration factors of various materials so that dentists can make their own choices based on case needs. The difference, she says, is that they do not teach to the use of a particular material, nor do they promote one material over another.
Practical Clinical Courses
3707 North Canyon Road, Suite 3D
Provo, UT 84604
Phone: 801-226-6569 | Fax: 801-226-8637
According to Gordon J. Christensen, DDS, MSD, PhD, ScD, founder and owner of Practical Clinical Courses, the word practical in the organization’s name says it all. Its continuing education programs maintain a strong focus on applications and products that dentists use every day in the course of routine clinical practice. While many other continuing education programs emphasize techniques, concepts, materials, and/or devices that are either expensive or only used or accomplished by those who are in the top level of treatment, the biggest advantages of Practical Clinical Courses are programs that present data and techniques that are researched in response to actual dentists’ questions and problems submitted to Clinicians Report Foundation.
“When a person comes through courses in our organization, they’re receiving up-to-date information as recent as a few days ago,” Christensen says. “They know it’s going to be backed by research, and they know it’s going to be something they can literally implement tomorrow.”
What leads mid-career clinicians to Practical Clinical Courses is a realization that they may still be using techniques they learned in dental school and they’re now way behind. However, when a dentist—regardless of their age—completes the hands-on courses, he or she will recognize very quickly the clinical and administrative areas that are increasingly becoming a pragmatic part of modern day-to-day practice (ie, periodontics, endodontics, implants, cone beam computed tomography, and others), Christensen says. These courses completely turn over every 2 years (ie, a course being attended today will be out of date in 2 years). Additionally, the organization’s annual update course, which changes every year, provides up-to-the-minute information in all course subject areas, he says. Subjects for Practical Clinical Courses also include practice management, an area that Christensen says is one of the biggest needs and concerns for recent dental school graduates pursuing continuing education.
“A new dentist has little or no knowledge or background in anything relative to business management, and that has put us in the situation we’re in right now financially,” Christensen says, referring to corporate dentistry models in which dentists are providers. “I could name only a few dental schools in this country that teach anything in practice management, such as how to hire, what kind of salaries to pay, what kind of qualifications staff should have, etc. All of these questions are beyond any new practitioner, so they may flounder, which is why they’re going into corporate dentistry.”
Although Christensen teaches 33 different technologies in his courses that are considered valuable to practice and patient care, the use of technology in continuing education is a double-edged sword. Its ability to make educational and instructional information accessible does lend itself to introducing dental students, newly graduated dentists, and mid-career dentists to a topic.
“However, we learn by doing, not by watching a picture and seeing somebody else do what we’re trying to learn to do,” Christensen says. “There has to be not only online orientation, but also hands-on courses.”
The trend educationally is for all dental clinicians to become consumers of information, rather than effectively assimilating information into their existing knowledge base. Therefore, given the plethora of information available for any clinician, and the ease with which it can be accessed, study clubs will become more relevant and critical to a clinician’s long-term growth and success in terms of continuing education.
“When we consume information, we don’t have the ability to use or recall it with ease. When that information becomes a natural part of the way we practice dentistry, when it has been assimilated, then we utilize it much more effectively and efficiently,” says Michael Cohen, DDS, MSD, founder of the Seattle Study Club. “Study clubs that focus on engagement, discussion, interaction, and the sharing of information between colleagues fill the need clinicians have to be able to utilize all of this information in daily practice.”
Compared to continuing education provided at dental schools or private institutes, Cohen explains that study club participation creates an environment for much-needed growth, change, and collaboration in a profession that can be quite isolating. As the dental industry changes, clinicians are realizing they need to do more than attend a few lectures or a single annual conference to stay relevant, he says.
“People hear about what we’re doing and realize it’s exactly what they need,” Cohen says. “After joining, they often can’t believe they ever survived without it and naturally want to share their experience with other clinicians.”
Word-of-mouth referrals, along with the ability—with careful management—to recreate the non-threatening, collaborative environment clinicians experienced in dental school, explains the significant growth that the Seattle Study Club has experienced.
Traditional CE is often lecture-based, Cohen adds, and it can be extremely difficult to take away knowledge that impacts behavior without interaction. Study clubs, on the other hand, have the potential to provide extremely effective education through interaction that enables testing, refining, and solidifying of ideas.
“In discussing the concepts presented with our peers, we consider perspectives that may never have occurred to us on our own,” Cohen says. “The study club can create a true university without walls where clinicians come together with the shared goal of improving themselves and their practice.”
Although there is no one formula that works for everyone, the Seattle Study Club does provide guidance to each of its local clubs to ensure they are meeting the needs of their individual communities. However, the real power comes from the collective knowledge of the group, with the core of education being an interdisciplinary approach to comprehensive care. Medical, financial, health, and other topics are integrated into the curriculum to provide all the tools necessary to create complete clinicians, Cohen says.
Essentially four goals direct the educational and mentorship endeavors of Spear Education when working with dentists: to enable clinicians to enjoy practicing more, to be more profitable, to have more free time, and to facilitate clinical skills growth to whatever level they desire, recognizing that different dentists have different aspirations. To achieve those objectives, Spear Education has developed its Eco-System of Learning, explains founder and director Frank Spear, DDS, MSD. This eco-system encompasses on-campus didactic seminars and hands-on workshops, as well as all of the information available through Spear Education online courses and study club modules.
“The fundamental motivation of a mid-career dentist to step into education is the desire to master something that can make dentistry fun, exciting, and enable them to treat patients they haven’t treated yet because they didn’t know what to do with them,” Spear says, adding that mid-career dentists today pursue continuing education for the same reasons they did 20 years ago. “Education for most dentists is about growing in competence, and the outcome of greater competence is confidence.”
Interestingly, Spear notes that when new graduates come to Spear Education, they’re not necessarily looking for something completely different. Given the absence of time and experience—two things dental schools cannot provide enough of in 4 years—new graduates seek to master what they’ve already learned in dental school and gain more competence.
“I think the biggest challenge with new graduates is that they just don’t know what they don’t know,” Spear says. “That was true 40 years ago; it was true 20 years ago; and it’s true today.”
Therefore, what Spear Education provides already practicing as well as newly graduated dentists is a much broader interpretation of how to diagnose, treatment plan, and think about patients they see in their practice through an interdisciplinary approach. Many patients in most practices have issues beyond what restorative dentistry alone can correct, and what’s required for treatment is teamwork, Spear says.
“We teach a model of diagnosis and treatment planning that basically says almost everything we do in dentistry can be put in four different boxes in terms of the procedures that are performed or the thought processes involved,” Spear says. One box is called call esthetics (ie, tooth position, tissue and papilla levels); another box is function (ie, occlusion, jaw joints, muscles); the third box is structure (ie, tooth restoration, replacement); and the fourth box is biology (ie, endodontics, periodontics, oral surgery). “The bulk of learning in most dental schools focuses on structure and biology, yet function and esthetics hold the answers to how to treat more complex patients.”
For years, Spear says, occlusion was viewed as the foundation of treatment, and if patients presented who didn’t have the occlusion that dentists believed they should, then that alone was justification to perform treatment. Dentists today live in a different era, he adds. Now it’s really about performing a thorough examination, diagnosing, thinking about the patient, asking the right questions, and then making a decision about whether treatment is needed or not.
Yesterday, Today, and Tomorrow
The differences between dental students then and now and what’s in store for continuing education
Dental Students 20 Years Ago (1997)
• Dental school tuition was minimal and in line with other vocations.
• About four materials to master (eg, amalgam, gold, composite, PFM).
• More patients available for dental school clinics and increased hands-on student work.
• Students still characteristic of the baby boomer generation (ie, relatively independent, linear thinkers and learners, entered dental school wanting experience/exposure prior to specific career decision-making).
Dental Students Now (2017)
• More debt after graduation—between $250,000 to $400,000 for tuition, books, instruments.
• More pharmaceutical-type agents, new restoratives and adhesives, and implants.
• Students graduate having completed only three or four crowns, suggesting a decrease in their volume of hands-on work.
• Higher expectations and more impatient; like collaborative and group work; very digital- and technology-oriented multitaskers; entered dental school knowing their ultimate specialty or practice goal.
• More women in dental school and the profession.
The Future of Continuing Education
• More information (text, video) available online, on-demand 24/7.
• Continued in-person learning with hands-on training combined with visual learning.
• Greater engagement, participation, and experiential programming to satisfy students who want more, faster, and sooner.