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J Dent Educ. 71(4): 511-515 2007
© 2007 American Dental Education Association
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Critical Issues in Dental Education

Educational Necessities to Compensate for Faculty Shortage

Reem Haj-Ali, B.D.S., D.D.S., M.S.; Mary P. Walker, D.D.S., Ph.D.; Cynthia S. Petrie, D.D.S., M.S.; Jasmin Steven, B.A.

Key words: peer tutoring, academic careers, recruitment

Submitted for publication 08/29/06; accepted 01/05/07


   Abstract
Top
 Abstract
Materials and Methods
 Results
 Discussion
 References
 
The purpose of this investigation was to evaluate whether senior dental students (4DS) could serve as effective instructors in a two-semester preclinical laboratory course and whether such teaching experience could enhance their interest in academics as a future career. Based on academic performance, five senior students were recruited to serve as instructors in a two-semester morphology/occlusion laboratory course in which ninety-five first-year dental students were enrolled. The first-year students were randomly assigned so that each student was instructed by a faculty member in one semester and a 4DS in the other semester. Outcomes included course evaluation forms completed by the first-year dental students at the end of each semester; a comparison of students’ performances in each course determined by faculty instructors and 4DSs; and the 4DSs’ self-report of their teaching experiences. Results showed no significant difference between the performance of 4DS and faculty instructors in all criteria evaluated (p>.05). Furthermore, there was no significant difference between the performance of students instructed by faculty members and those instructed by 4DS in either semester (p>.05). Despite the fact that such experience seemed to have minimal influence on students’ decision to consider academics as a future career, 4DSs do seem to provide effective instruction and thereby can serve to compensate for faculty shortages.

Not only have new dental schools opened, but more are being planned at East Carolina University (North Carolina), Midwest University (Arizona), and the Western University of Health Science (California).1 As severe as the faculty shortage crisis is, it seems it will get worse before it gets better. The number of dentists seeking a career in dental education has not kept up with the demand.2–5 Additionally, because the number of dentists per capita is declining, the need for additional dental students and educators can be expected to increase further.6 In fact, surveys of all the dental schools in the United States conducted by the American Dental Education Association (ADEA) reported vacancies ranging from 275 to approximately 300 nationally over the past five years.7–10

While multiple strategies to recruit and retain dental school faculty are being developed and implemented,6 immediate solutions are required so that effective classroom and clinical instruction can be maintained. One potential approach could be to utilize fourth-year dental students (4DS) as instructors in preclinical laboratory courses. The purposes of this investigation were to evaluate whether 4DSs could be utilized as effective instructors in a two-semester morphology and occlusion preclinical lab course and whether such an experience would encourage these students to pursue a career in dental education.


   Materials and Methods
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 Abstract
 Materials and Methods
Results
 Discussion
 References
 
Ninety-five first-year dental students (1DS) attended two-semester morphology and occlusion laboratory courses (fall and winter semesters). Five senior students (4DS) selected on the basis of their dental school performance and five full-time faculty members (FT) served as instructors. This resulted in one instructor per a group of nine to ten students. Each of the 1DSs was randomly assigned to be supervised by one of the FT instructors in one semester and by one of the 4DS instructors in the other semester. This approach allowed each student to interact with an FT as well as a 4DS instructor.

The instructor’s role, whether student or faculty instructor, was to supervise, give feedback, and evaluate daily projects for his or her group. Prior to each laboratory session, the course director met with the instructors and had a discussion over the project of the day. The foci of the discussion included explanation of the project and its objectives; criteria for evaluating the student outcome; and an explanation of what constituted ideal, acceptable, and standard not met for each criterion. The same discussion was repeated by the course instructor with the students at the beginning of every lab session, aided by a live demonstration using a camera projector. Additionally, the instructors’ role included participation in grading final examinations.

At the end of each semester, standard School of Dentistry course evaluation forms were mailed to the 1DSs, who voluntarily evaluated the instructors on each of six criteria: 1) contribution to student knowledge, 2) ability to create a positive learning environment, 3) ability to communicate effectively, 4) availability, 5) fairness in grading, and 6) overall teaching effectiveness of the instructor. The scale provided for a rating on each criterion was "poor (1)," "fair (2)," "average (3)," "good (4)," or "excellent (5)." Additionally, a short survey was attached to the evaluation forms in which 1DSs were questioned on their reactions to having 4DSs as their instructors in the preclinical labs. At the end of second semester, 4DS instructors were also mailed a short questionnaire soliciting information regarding their reactions to this teaching experience and whether it might have influenced the future course of their professional activities, particularly whether it might have motivated them to consider some role in dental education. Included with the mailed evaluations and questionnaires were instructions requesting the instructor to complete and return the form in the return envelope within a two-week period. No other student identifiers were used. Two weeks after the initial mailing, follow-up reminder emails were sent to students.

The data contained in the returned evaluations and questionnaires were evaluated via SPSS statistical software (v. 12.0.2, SPSS Inc., Chicago, IL). Ratings for both instructor groups—student and faculty instructors—were compared using nonparametric Wilcoxon matched pairs signed rank test, {alpha} level of .05. Descriptive statistics were used to describe students’ responses to questionnaires.

To assess teaching effectiveness, first-year dental students’ final examination scores in each of the two preclinical labs were compared using an independent t-test. These examinations consisted of two waxing exercises and an objective structured clinical exam (OSCE) in the fall semester, plus a face-bow transfer with mounting casts in maximum intercuspation position exercise and another OSCE in the winter semester. To ensure that evaluators were blinded as to whether the student they were evaluating had a faculty or a senior student instructor for the semester, 1DSs were randomly assigned, by the course instructor, a number from 1 to 95 and were requested to use this number as an identifier on their exams. The grading of both OSCE exams was done by comparing students’ answer sheets with an answer key prepared by the course director. As for the waxing and mounting exercises, raters received one-hour calibration training prior to grading. The foci of the training included explanation of the criteria on the grading forms for each project, the test to use for each criterion when applicable (what instrument to use and how), and an explanation of what constituted ideal, acceptable, and standard not met for each criterion. This was aided by project samples selected from students’ previous practical examinations representing various ranges of acceptability for the criteria. Throughout the calibration training session, there was opportunity for questions and debate. Raters were then randomly divided into groups of three, and each group was given approximately a third of the class test projects to be evaluated. First, each rater independently evaluated the final project, and when done, evaluations from each instructor were compared. Any discrepancies among the raters were discussed, and a resolution sought.


   Results
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 Abstract
 Materials and Methods
 Results
Discussion
 References
 
Forty-three of the first-year dental students completed instructor evaluation forms, which represents a 45.3 percent response rate. Table 1Go provides descriptive data for freshman students’ evaluation of both 4DS and faculty instructors for each criterion. Frequency distributions and medians were virtually identical for both groups, with no statistically significant difference (p>.05) for any criterion. For both instructor groups, the median on each criterion was a rating of "good."


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  		Table 1. Medians and interquartile ranges (IQR) of full-time faculty (FT) and senior dental student (4DS) instructors’ performance in each criterion as evaluated by first-year dental students
 
Table 2Go displays mean examination scores, expressed in percentage, in each semester of the course for first-year students supervised by faculty and by 4DSs. In the fall semester morphology lab, the average final exam scores for students instructed by faculty and 4DSs were 86.2 percent (SD 6.7) and 86.3 percent (SD 5.6), respectively. In the winter semester occlusion lab, mean scores for students instructed by faculty and 4DSs were 88.6 percent (SD 7.3) and 89.8 percent (SD 6.9), respectively.


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  		Table 2. Percentage means and standard deviations of first-year dental student performance in both morphology and occlusion preclinical labs
 
Table 3Go provides descriptive data for 1DS reactions to having senior dental students as instructors. Approximately 42 percent of the 1DSs felt more comfortable with faculty member instruction, and 16.3 percent felt deceived by having 4DSs as their instructors. Yet 62.8 percent agreed or strongly agreed that they would be willing to serve as a future student instructor.


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  		Table 3. First-year dental students’ responses to questionnaire
 
Table 4Go provides descriptive data on the questionnaire completed by 4DSs. While all five student instructors agreed or strongly agreed that the experience provided good exposure to teaching, that it reinforced their dental knowledge, and that they would encourage other students to participate in the future, only one participant agreed that the experience would influence his or her decision to consider teaching as part of a future career.


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  		Table 4. Senior dental students’ (participating student faculty) responses to questionnaire
 

   Discussion
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 Abstract
 Materials and Methods
 Results
 Discussion
References
 
The source of our faculty shortage dilemma is simple: more faculty members are leaving than entering dental education. Many factors have been identified to account for this situation. On the one hand, we are faced with continuous faculty separation. The most commonly reported reason for faculty separation has been attributed to entering private practice, where the dental needs of the public continue to increase.8–10 Exacerbating the situation is the retirement of many current faculty members.7–10 With 55 percent of full-time faculty being age fifty or older and 20 percent over the age of sixty, it is anticipated that retirement of this group will create a high number of academic vacancies by the next decade.11

On the other hand, failing to recruit adequate numbers of faculty, particularly younger educators, fails to maintain the status quo. The debt load of new graduates makes it far more advantageous to enter private practice than dental education. Forty-five percent of dental students who completed their studies in 2000 had a debt exceeding $100,000.12 Further, most students enter a dental program intending to be in clinical practice. The percentage of graduates between the years 2001 and 2004 choosing academia as a career after graduation has been reported well below 2 percent, or fewer than 100 new graduates per year.2–5 With an annual need of 275–300 new faculty members, clearly the demand continues to exceed the supply of new dental educators.6,11 With minimal interest in pursuing a career in dental education among new members of our profession, the prognosis is alarming.

Between anticipated faculty retirements and current levels of faculty turnover, continued support for and development of faculty recruitment and retention programs remain essential to maintaining a quality dental education workforce. In the meanwhile, dental educators must determine how to maintain an effective instructional environment in the absence of sufficient faculty.

Some argue that some dental students might consider a career in dental education if they had exposure to the teaching enterprise during their four-year program.13,14 Others have suggested that perhaps a key to educating students about the rewards of academic dentistry may be to offer predoctoral teaching assistant opportunities.6

This study sought to provide such experience to senior students and to determine if the instruction provided by these individuals equaled the effectiveness of that provided by full-time faculty. The results showed that the two-semester teaching program in the first-year morphology and occlusion course maintained teaching effectiveness with senior dental students functioning as instructors. Evaluation of instruction was equivalent for both 4DSs and faculty from students’ perspective, and students’ performance on examinations at the end of each semester was virtually identical, regardless of supervision by students or faculty.

With the dual requirement to improve teaching quality while doing more with less, many professional schools have increased utilization of peer tutoring.15 Nursing, medical, pharmacy, and other professional schools have used this instructional method as a means to compensate for faculty shortages.15–18 There is considerable evidence supporting the positive effects of peer tutoring on examination scores, students’ satisfaction, and personal and professional development.19 It is thought that peer tutors can better understand the learning problems of fellow learners and provide instruction under a more active interactive and less authoritarian environment. Yet one disadvantage was observed from responses of freshmen: a small percentage (16 percent) felt deceived by having senior students as instructors, and about 45 percent favored having a full-time faculty. Students assume that the quality of tutoring from other students may be a great deal inferior to that from a professional teacher; therefore, the need for monitoring of student instructors and quality control through adequate instruction, calibration, and supervision should not be underestimated.

In addition to having positive effects on learners, peer tutoring affects student instructors as well. By assuming the responsibility of teaching their peers, students not only improve their understanding of course content as noted from seniors’ responses, but also develop communication skills, teamwork, leadership, confidence, and respect for their peers that are vital to developing professionalism early in their dental careers.19

Despite these advantages, the teaching program failed to persuade senior students to consider teaching as a professional career. Most of the participating senior students did not indicate that their interest in academia was piqued by this experience. It may be that the teaching program was designed to focus mainly on compensating for faculty shortages without placing sufficient emphasis on faculty recruitment. The program failed to portray the positive aspects of academic careers as a fair balance to the negative concerns of dental graduates regarding their debt loads. In surveys conducted to determine factors that influenced new faculty to choose academic careers, issues such as the working environment, educational resources and facilities, opportunities for faculty development, and the variety of work activity available in academia were all important positive influencing factors.20,21 Additionally, retirement and other benefits and the predictable stable source of income should be emphasized to potential faculty so they can appreciate the full picture of academic compensation versus private practice.21

As with any other survey, nonresponse bias seemed to be an associated limitation. With students being bombarded with course evaluations at the end of each semester, it is not surprising that the response rate to this survey was low (45.3 percent). As such, this study could provide a foundation for future studies aimed towards developing tutoring programs that act as a temporary solution to faculty shortages, while at the same time providing a more enduring solution through adopting specific strategies targeting recruitment of new graduates.

In conclusion, the use of this program may be of interest to seniors and could act as a temporary means to compensate for faculty shortage. Course effectiveness was maintained when five senior dental students served with five faculty members as lab instructors.


   Footnotes
 
Dr. Haj-Ali is Assistant Professor, Department of Restorative Dentistry; Dr. Walker is Associate Professor, Department of Restorative Dentistry; Dr. Petrie is Associate Professor, Department of Restorative Dentistry; and Ms. Steven is a dental student and participant in the Dental Research Scholars Program—all at the School of Dentistry, University of Missouri-Kansas City. Direct correspondence and requests for reprints to Dr. Reem Haj-Ali, Department of Restorative Dentistry, School of Dentistry, University of Missouri-Kansas City, 650 East 25th Street, Kansas City, MO 64108; 816-235-2012 phone; haj-alir{at}umkc.edu.


   REFERENCES
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 Materials and Methods
 Results
 Discussion
 References
 

  1. Fox K. New dental schools proposed. ADA news, December 2006. At: www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1900. Accessed: December 2006.
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