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From the Students' Corner |
Key words: student research, training programs, student recruitment, curriculum change, dental careers, mentorship
Submitted for publication 02/19/06; accepted 05/18/06
| Abstract |
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One of the primary concerns in dental education is the number of vacant faculty positions. There were an estimated 241 vacant full-time and fifty-five part-time faculty positions at the fifty-six U.S. dental schools in 200304.1 Given that the NIH Dental Scientist Training Program Awards seek to produce future leaders and dental scientists, efforts to expand and promote these programs to students need to be enhanced. In a recent "From the Students Corner" article, Ryan Edmunds stressed the need for research exposure in the dental curriculum.2 Doing so serves not only to interest students in different dental specialties and encourage them to undertake research as a future practicing dentist, but also exposes future career dental researchers to the various training options available to them. These sentiments have been expressed by Bruce Baum, chief of the Gene Therapy Branch at the National Institute for Dental and Craniofacial Research (NIDCR), in several articles over the last decade. Dr. Baum details the need for increased research and training opportunities in the dental curriculum by citing examples and professional successes from the medical education community.35 Briefly, Dr. Baum seeks to compare the advancements made within medicine via the biomedical sciences to the fairly stagnant and historical training of dentists. In a 2004 survey of more than 4,000 dental school graduates by the American Dental Education Association (ADEA), only 0.5 percent had plans to focus on teaching or research.6 Philip Stashenko and his colleagues at the Forsyth Institute in Boston have recommended that dental schools increase their recruitment of students interested in biomedical science to up to 20 percent of the class in hopes that one quarter of these students will pursue academia/research as a career.7
Medical education and practice have embraced biomedical science within the individual disciplines in their standards of care, but dental education and practice have largely been focused on the technical skills required to provide dental care, prompting Dr. Baum to ask, "Will Dentistry Be Left Behind at the Healthcare Station?"8 Indeed, to date, only one dental school has completely and comprehensively changed its curriculum to support student research/scholarship across the entire four-year program as a normal part of the educational experience.9,10 Marquette University School of Dentistrys new curriculum contains a dedicated research/scholarship track, required of all students, which makes training and experiences in research feasible and accessible during regular curricular hours.9,10 This curricular approach was taken to specifically stimulate interest in academic/ research careers.
In 2004, Marquette University School of Dentistry combined forces with the University of Rochester Graduate School to create the only dual-institution dental scientist training program. This program is supported through the University of Rochesters NIH T32 award. Dental students at Marquette, in addition to the mandatory research/scholarship track at Marquette, have the opportunity to combine their dental training with graduate science training at the University of Rochester in a combined program leading to both the D.D.S. and the Ph.D. degree. Further discussion of the details of this program appears below.
My goal for conducting this study was to identify and describe opportunities for students interested in formal scientific training during their predoctoral dental school careers. In doing so, I do not seek to address the reasons for the lack of interest and/or access to research training in U.S. predoctoral programs, but instead focus on the challenges facing students seeking information about training programs as well as faculty/administrators seeking to advertise and market these programs.
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| Results |
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While only the above-named three schools provided any response to the survey, through the initial website review I identified four dental schools that contain comprehensive sections of their website dedicated to their dental scientist training program: University of California, Los Angeles,12 Medical University of South Carolina,13 University of Maryland/ Baltimore College of Dentistry,14 and University at Buffalo.15 The content of websites for the remaining schools varied depending on the institution. Many dental schools do not discuss research directly on their websites; therefore, an additional search of the individual websites with the key words "research," "training," and "Ph.D." was executed. The results based on the individual survey responses and the website review are summarized in Table 3
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All programs support basic science research, and UCSF also conducts a clinical research program. The programs at Marquette University/University of Rochester, UCSF, and Washington are structured in a similar fashion: a student will enter and complete three years of dental school with provisions made in the summer to undertake research rotations or additional coursework. Upon completion of the third year of dental school, the student will enter formal graduate study and complete his or her dissertation research, with the D.D.S. being awarded some time throughout or subsequent to this phase of training. Marquette University/University of Rochester was the only program designed to grant the student the D.D.S. after the fourth year. The University of Washington confers the dental degree upon completion of the sixth year, and UCSF will confer the degree after the seventh year or when the student begins to write a dissertation. Both Marquette University/University of Rochester and UCSF are funded through NIH T32 training awards, while the University of Washingtons NIH T32 application for one to two students per year is in progress; currently, it supports students with funds from the university and the Washington Dental Service. All three schools indicated that both a progressive administration and enthusiastic students were instrumental in establishing their programs. Marquette University School of Dentistry is the only school using the R25 grant mechanism to support a comprehensive curricular and cultural change that facilitates combined training programs.9,10 The NIDCR R25 Oral Health Research Curriculum grant mechanism has allowed Marquette to incorporate research directly into its new curriculum structure, encouraging formal mentored research as well as identifying and supporting future dual-degree candidates.9,10 The University of California, San Francisco was the only school graduating a student from its program and indicated the student planned to pursue a pediatric dentistry residency.
Comprehensive Web Search Results
The four dental schools with more detailed information on their websites were: University of California, Los Angeles (UCLA), Medical University of South Carolina, University of Maryland, and the University at Buffalo. These schools are supported by the NIH T32 training award although details regarding how the program is structured varied depending on the school. UCLA indicated that Ph.D. training can be obtained in disciplines of bone biology and bioengineering, head and neck cancer, and microbiology and immunity.12 The Medical University of South Carolina (MUSC) provides basic science intramural training or extramurally in cooperation with the NIDCR in Bethesda. The MUSC program also provides a $21,000 stipend and reduced tuition throughout the life of the program. This program is designed to be seven years in length, in which the student will complete one year of dental school followed by three years of research before returning to the dental curriculum for the final three years; both degrees are awarded at the end of the program.13 The University of Maryland/Baltimore College of Dentistry also provides a stipend and financial support throughout the seven-year life of the program, but does not specify the level of financial support. Students can pursue any of the topics from the University of Maryland School of Medicines Graduate Program in Life Sciences.14 The University at Buffalos program is designed to last approximately eight years. In the first two years, the students take many basic science and dental school courses and pass their preliminary exam leading to the Ph.D. They will then move exclusively to the dental school for two years to complete their clinical training and ultimately spend the final three to four years conducting their dissertation research. Financial support is provided for students in the program, but details about the type of research were not provided on the website.15 Websites for these four schools provided contact information for further questions. However, introductory and follow-up surveys sent by email to the individuals and addresses indicated on these sites were not answered.
Other Schools Search Results
Electronic searches of the schools that did not provide comprehensive descriptions of their dental scientist training programs at their main website revealed varying degrees of information. The Ohio State University College of Dentistry,16 University of Connecticut School of Dental Medicine,17 University of Missouri-Kansas City School of Dentistry,18 and University of Texas Health Science Center at both Houston (UTHSC-H)19 and San Antonio (UTHSC-SA)20 are supported by NIH T32 awards, but none of these schools described the specific structure of the program or discussed the level of financial support. Websites at these schools only provided contact information for further questions.1620 Introductory and follow-up surveys sent to the addresses on these websites were not answered.
Five of the twenty-two schools that have a dental scientist training program are not currently supported by NIH T32 awards: Loma Linda University,21 Medical College of Georgia,22 University of Illinois,23 University of Medicine and Dentistry of New Jersey,24 and University of Pennsylvania.25 Of these five schools, only the Medical College of Georgia (MCG) describes the structure of the program on its website. At MCG, students will complete the first two years of dental school, followed by approximately three years of research, and then return to the dental curriculum for the final two years. The availability of financial support for students in the program is not discussed.22 The remaining schools imply that an allowance is available for students to complete a dual degree concomitantly with the graduate program at the university and offer contact information for further questions. Introductory and follow-up surveys sent by email to the addresses provided on the websites of these dental schools also went unanswered.
Direct Student Contact Results
During the 2006 ADEA/AADR Annual Session, the National Student Research Group held a breakfast to begin to build a network for current dental scientist trainees. I contacted two students from the University of Texas Health Science Center at Houston (UTHSC-H) and one student from the Baylor College of Dentistry to obtain a general impression of their experiences. All three students responded enthusiastically about their programs.
Students had different experiences when applying to their programs. One student at UTHSC-H and the student from Baylor discovered the program while already in dental school. Both were totally unaware of the opportunity to complete dual-degree training prior to matriculation. The other student at UTHSC-H applied specifically to schools that have dual-degree programs. He indicated that he did have some difficulty obtaining details about the program prior to the application process.
Both students at UTHSC-H indicated that the recruitment of new students is being de-emphasized. The student from Baylor commented that the dual-degree opportunities were completely hidden from his admission process. Only one student (UTHSC-H) was aware of the opportunity to complete dual training during dental school and turned down other schools that he was admitted to because they did not offer this training.
All schools were supported by the Institutional Dental Scientist Training Program (NIH T32), and Baylor indicated that some students have been supported by the Individual Dental Scientist Training Award (NIH F30). All three students were confident that they would complete their training. At Baylor, the school has verbally agreed to support all their current trainees if any unforeseen budget issues arise. The NIH T32 funding mechanism at UTHSC-H will be reviewed again in two years, and both students have indicated that they will apply for NIH F30 awards to secure individual funding regardless of the institutional grant (NIH T32). Due to the competitive nature of the review process, both students commented that this is the reason that UTHSC-H is not actively recruiting new students. Both schools indicated that there was a program director who directly facilitates financial support among other duties.
All students who participated in this adjunct survey indicated they had an interest in pursuing a specialty and ultimately an academic appointment. The student from Baylor indicated that, of the ten students that he can recall who have completed the program, three have remained in a substantive academic/research career.
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Implications for Current Dental Students
Opportunities abound to pursue research during dental school, and while students like Ryan Edmunds2 and I will continue to spend our dental careers encouraging schools to promote and support further predoctoral dental research experiences, students should not overlook the current opportunities to participate in formal training. The following are recommendations for all current dental students:
Implications for Dental Schools
If the word for current and future applicants is persistence, the word for current dental schools is recruitment. Stashenko et al. recommended that the current student body of dental schools should consist of at least 20 percent students who are interested in careers in biomedical research and desire to pursue the dual degree.7 If even one quarter of these students become dental school faculty and researchers, this would represent a tenfold increase in the current numbers. The very low response rate to this survey (n=3/22; 13 percent) among the twenty-two schools that appear to have dual-degree programs indicates to me that dental schools are not encouraging potential dental scientists to follow the path that dental education so desperately needs. Many of these potential dental students may instead go on to pursue research degrees (Ph.D.), seeing dentistry as a highly technical discipline that lacks a true biomedical foundation at the practice level. In 200304, the number of vacant full-time basic science faculty positions was reported at thirteen (4.5 percent), while the number of vacant full-time clinical science positions was 183 (63 percent).1 Loma Linda University has recognized the potential implications of a faculty shortage. In their article, Charles Goodacre and William Loveless discuss the schools new program designed to recruit Ph.D.-level scientists and then sponsor their training in dentistry, demonstrating their desire to enhance the percentage of research-trained faculty members.26 Sara Werb and David Matear, at the University of Toronto, have tackled the question of how to best incorporate evidence-based dentistry into the undergraduate dental curriculum. They specifically cite clinical instructor misapprehension as the common barrier to training dental students in evidence-based dentistry and recommend faculty development for these instructors to enhance their knowledge of current research and relevant literature.27 Such programs seek to develop a new breed of dental educator as both clinician and basic science faculty member. The dual-degree dental scientist program offers an efficient method to train these new potential faculty members.
Current dental students taking their first-year classes often see biomedical sciences as purely a rite of passage with little regard to the subject matter once board exams are over.6 Training and recruiting faculty members who possess this dual training truly integrate the technical and clinical aspects of dentistry with the basic biomedical sciences that support them. Seeing a D.D.S.-D.M.D./Ph.D. as only a scientist is as puerile as seeing a D.D.S.-D.M.D. as simply a clinician; however, recognizing this potential talent opens up the possibility to combine clinical and basic science faculty and begins to chip away at the current combined 196 vacant full-time faculty positions.
Many current faculty members already have this dual training. I am in no way disparaging their tremendous efforts in the uphill battle they had to endure to be formally trained as a clinician and scientist. This option was more feasible in the past, but the increase in the average debt for graduating dental students, from $84,247 in 1990 to $135,721 in 2004 (61 percent increase), at all schools has become a major barrier for students interested in pursuing research careers.6 Of those seniors who entered private practice, 71.6 percent listed debt as a "factor" or a "major factor" that influenced their decision.6 If a mechanism to fund further formal training had been available, it is reasonable to believe that some of these students would have given serious consideration to other career paths within dentistry.
It is not enough that dental schools recruit and encourage students by establishing programs that make a career in research feasible. Dental schools must go further in supporting these students financially by securing grants and providing other funding mechanisms to promote their future faculty and researchers. I certainly cannot specify all the possible solutions in this article; however, I believe that expansion of dual-degree dental scientist training programs can only occur if interested students continue to pressure administrators to make opportunities accessible and feasible. At the same time, these administrators must continue to establish, support, and promote current and future programs.
The following are recommendations for all dental schools:
| Acknowledgments |
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| REFERENCES |
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This article has been cited by other articles:
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J. M. Roger The Academic Dental Careers Fellowship Program: A Pilot Program to Introduce Dental Students to Academia J Dent Educ., April 1, 2008; 72(4): 438 - 447. [Abstract] [Full Text] [PDF] |
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J. M. Roger, M. M.H. Wehmeyer, and M. S. Milliner Reflections on Academic Careers by Current Dental School Faculty J Dent Educ., April 1, 2008; 72(4): 448 - 457. [Abstract] [Full Text] [PDF] |
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J. A. Horst Bootstrapping Student Publication in the JDE: An ADEA Council of Students Initiative J Dent Educ., October 1, 2007; 71(10): 1265 - 1266. [Full Text] [PDF] |
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