AEGD Programs: Why Now, Why More?

AEGD Programs

According to the 2008–09 Survey of Advanced Dental Education published by the American Dental Association, the number of AEGD programs has remained fairly constant over the past seven years.² However, enrollment is up in existing AEGD programs, as well as in General Practice Residencies and several dental specialty programs.³ While applications to AEGD programs have increased, the number of applications varies annually depending on the number of programs to which each student applies. Thus, the number of applications can be an indicator of competitiveness in a discipline from year to year, and by current indications, it is becoming more competitive to get into an AEGD program (Table 1).

This increase in applications, in some ways, may be linked to a change in students’ beliefs that postdoctoral education should be required or at the least that it is a beneficial adjunct to the typical dental curriculum. According to the 2009 American Dental Education Association (ADEA) survey of dental school seniors, only 25.6 percent of the 1999 graduating students agreed that a postdoctoral year be required, while 37.1 percent of seniors in 2009 held this belief.⁴ This trend appears to indicate that more students are interested in seeking postdoctoral training opportunities than in the past. A previous study determined that important attributes in selecting a graduate opportunity were intellectual content, challenging diagnostic problems, and programs that help build special skills or unique talents.⁵ Another study found that patient management issues were a strong motivating factor for those pursuing postdoctoral training.⁶

While it is natural to assume that the amount of educational debt accrued might affect a graduate’s decision to spend the extra time required in getting postgraduate training, the most recent ADEA senior surveys (for 2002 to 2009) found that this is not true of those pursing advanced education.⁴ In spite of rising tuition rates and increased debt among graduates, those students pursuing advanced education opportunities remain the group least influenced by the amount of debt (Table 2).

In the 2003 ADEA senior survey, the question of educational debt influencing immediate plans was asked to elicit a reflective answer rather than just a yes or no response.⁷ Participants were asked what they would have pursued if it were not for their educational debt. Only 12.8 percent of the respondents would have chosen a postgraduate plan different from AEGD. This was a much lower percentage than all other categories of respondents who would have chosen another option. For instance, 45.6 percent of those employed in community clinics would have chosen to go into a solo private practice or a group practice if they could have.

Survey of Current AEGD Residents

To investigate reasons for the increase in AEGD applications, we conducted a survey in 2011 using the online survey tool SurveyMonkey to ask nine questions of all current AEGD residents. The survey contained five-point rating scale questions with choices ranging from “not important” to “extremely important,” after corrections made based on feedback from a survey specialist. The project was then submitted to the Institutional Review Board (IRB) at the University of the Pacific Arthur A. Dugoni School of Dentistry. Following IRB approval, a website link for the anonymous survey was obtained, and an invitation to participate was created. The survey was then sent by e-mail to all AEGD program directors across the United States with instructions for completion by their AEGD residents. Two separate e-mail reminders were sent three weeks apart to each program director requesting the participation of their AEGD residents in the study. Participants were informed that the survey was anonymous and that there were no incentives for providing responses. The summary of responses from the 112 respondents is shown in Table 3.

Some interesting findings came out of this summary. The overwhelming reason respondents chose to participate in an AEGD program was a desire to increase their knowledge and clinical skills (Question 2). Along with an opportunity to do more clinical dentistry (more restorative procedures, Question 7) and an opportunity to learn about technological advances in restorative dentistry (Question 9), this finding demonstrates that two of the primary reasons respondents chose an AEGD program was to increase their clinical skills and provide better care to their patients. While this appears to be due to in part to a feeling of unpreparedness to enter private practice after graduation from dental school (Question 1), it is interesting to note that increasing skills predominated over other issues offered in the survey.

In the results, we also discovered that a group of respondents considered having an AEGD residency acting as a substitute for a clinical licensure exam (Question 6) an important component of the program. While we do not know how many of our responses came from students in states where a yearlong residency program can be used for licensure, these results indicate that this issue is but one piece of the process in elucidating why graduating dental students are investigating enrolling in an AEGD program. While the percentage was not as high as in some other categories, this is an interesting issue and one that will probably change with time if more states adopt this policy.

Opportunities for student loan deferral (Question 4) and the opportunity to wait for better practice opportunities following U.S. economic recovery (Question 5) did not appear to be motivating factors for most of the respondents. This may indicate that while monetary issues typically play some role, for most applicants this challenge does not outweigh the desire to increase the skill and knowledge base that an AEGD program will provide.

The ability to gain more exposure to the management of medically compromised and special needs patients (Question 3) received responses across the spectrum of choices, indicating that it was an important issue for some while not as important for others. However, almost all of the respondents attached some level of importance to this opportunity. Whether this finding is due to few opportunities in the predoctoral curriculum to treat people with special needs and medical complexities or a desire to become more proficient, those within an AEGD program do attach significance to the opportunity to treat these patients.

Finally, not many respondents attached importance to the ability of an AEGD program to prepare them to enter an academic career (Question 8). While it is encouraging that 30 percent of those who answered the survey saw this as at least somewhat important, we had hoped that this number would have been higher as this is a group that will receive the training and experiences to make them excellent dental academicians. Dental schools and AEGD programs can use this finding to increase awareness among dental students that general dentistry residency programs foster the training of future faculty members.

Comments from Survey Respondents

A number of AEGD residents provided additional comments about their reasoning for choosing an AEGD program beyond the questions posed in the survey. Most comments were in relation to Question 2 regarding the desire to increase knowledge and clinical skills. Residents reported that this factor was of primary importance to them for two main reasons. First, many sought to gain training in complicated procedures not part of a typical dental school program, such as implant dentistry, esthetics, using IV sedation, crown lengthening, and more complicated periodontal surgical techniques. Second, several residents thought that their dental school training did not provide enough clinical experiences and that the AEGD program would allow them to gain confidence in their general dentistry skills. Interestingly, some comments were made that AEGD training would provide the students with the opportunity to work closely with different specialists and gain a better understanding of treatment planning complex cases.

For many residents responding to our survey, an AEGD program was seen as a way to prepare for particular career choices. Many mentioned that the military branches prefer their dentists to obtain AEGD training and that there are greater opportunities for advancement with this training, while some mentioned that AEGD training would make them more appealing and competitive in the current job market. Additionally, for a subset of respondents, AEGD represented a means to become competitive for application to dental specialty programs.

The other interesting point mentioned by a few of the survey respondents was that AEGD would give them access to the operating room for treating patients with special needs. Along the same lines, others mentioned that AEGD training would give them exposure to populations of patients not seen often enough in their dental program, such as geriatric patients or complicated pediatric patients.

AEGD Programs’ Contribution to Current Issues

There are multiple reasons why students choose to pursue an AEGD program, and multiple aspects of an AEGD program can contribute to the development of a well-trained health practitioner. In spite of this variety, these programs can be utilized by the dental profession to address several of the following issues.