Table of Contents

Periodontics

Inside Dentistry

October 2006, Volume 2, Issue 8
Published by AEGIS Communications

Who Makes the Rules, What Makes It Effective and How Are Standards Monitored?

Allison M. DiMatteo, BA, MPS

As technology and new science become available to the profession at a rapid rate, professionals are faced with the challenge of translating and applying those innovations into meaningful practice. So now, more than ever, continuing education (CE) is a necessity, not merely an option.

Almost all of the estimated 173,574 professionally active dentists in the US1 are required to earn a specified number of new CE credits every one to three years—depending upon the state in which they practice. Currently 47 out of 50 states in which they could practice have some requirement for CE in order for them to maintain their licenses; Colorado, Wisconsin and Wyoming do not, although the latter does require dental professionals to have basic life support certification.

As William R. Yancey, DDS, the assistant dean and director of continuing dental education and alumni affairs for the UCLA School of Dentistry explains, dentists are now operating in an age in which new materials are coming to market monthly. The techniques with which they’re used are extremely important now.

“We have gone from a materials stage, where technique was not nearly as important as it is today, to a stage where technique is extremely important, down to the most minor detail,” Yancey clarifies. “None of this can be covered in its entirety in the dental school curriculum anymore. We are in an age where CE is essential.”

Laura M. Neumann, DDS, MPH, associate executive director of the division of education of the American Dental Association (ADA), says the purpose of CE is to convey information beyond basic dental education, to update knowledge on advances in dental and medical sciences, and as a goal, to improve the abilities of individual dentists to provide the highest quality of care to the public. All dentists have the obligation to keep their knowledge and skills current, she says, and that requires quality continuing education.

Within the CE environment, increasing numbers of providers are sprouting up everywhere. On the one hand, these afford dental professionals opportunities to earn needed credits through an expanding array of learning scenarios, and at varying costs (See Who Needs What & What’s the Cost?, page 54). Online multimedia and at-home study continue to grow. Additional sources of CE include dental associations and trade shows; dental publications; university-based seminars, continuums and courses; private institutes; key opinion leader lectures; and manufacturer-sponsored programs, among others.

On the other hand, with so many ways to obtain CE credit, where do you turn? Among the considerations dentists take into account are word-of-mouth recommendations from fellow colleagues, interest in course material, marketing, and provider reputation, notes Vangel R. Zissi, DMD, from Tufts University School of Dental Medicine. Referrals from previous course participants can also be helpful, Yancey says, as can the reputation of the CE provider itself.

Can you assume that any and all CE credits you earn from anywhere and at any time will be accepted and help you meet your relicensure requirements? According to Marsha Stiegel, manager of the ADA Continuing Education Recognition Program (CERP), individual states differ in what they allow and require in terms of CE for relicensure; what’s more, the expectations are constantly changing. Some require only basic life saving skills. Others don’t allow credits earned from practice management courses. Some have a limit on how many credits can be earned through self study. Some require on-site, in-class participation.

Obviously, relicensure requirements should be considerations when choosing which CE endeavors to undertake. However, short- and long-term goals should also come into play. According to Steve Ratcliff, DDS, director of academic affairs for The Pankey Institute for Advanced Dental Education in Key Biscayne, FL, selecting from among the CE choices in order to obtain mandatory and elective credits boils down to clinicians wanting to create a preferred future for themselves and recognizing that learning is a lifelong process.

“I have had the opportunity to meet hundreds, maybe thousands of dentists whose skill and success levels are across a very broad spectrum,” explains Ratcliff. “The ones whose practices I would most like to emulate are the ones who put themselves into significant learning experiences every six to eight weeks—whether it’s engaging in a three- or four-day seminar at a place like our institute or interacting with a group of peers or colleagues who meet in a study club with a mentor or facilitator in a guided situation.”

The strategy for prudent on-going education would seem straight-forward enough, but there are those in the administration and instruction of dentistry who are becoming increasingly concerned about what’s available for CE. As more and more “educational” opportunities are introduced that market courses designed to teach clinicians how to sell dentistry, rather than provide quality dentistry, some people worry that professional attention is shifting away from care and needed services.

“I think the institutes that are out there—and there are some very good institutes, as well as some questionable ones—should consider some sort of accreditation, although it is not available at this time,” suggests Richard J. Simonsen, DDS, MS, dean of Midwestern University College of Dental Medicine. “Without some form of recognition or accreditation, clinicians are really at the mercy of the entrepreneurial efforts of the institutes, and it could lead to some over-commercialization and courses and treatments designed for maximum profit, not the best health outcomes.”

According to Marshall Shragg, MPH, the executive director of the Minnesota Board of Dentistry and the president of the American Association of Dental Administrators, CE is just one component of professional development. There are many excellent resources available to dental professionals to assist them in maintaining knowledge and competence so that they continue to meet professional standards and expectations.

But, he also cautions that there are also many marginal or poor choices that dentists, hygienists and assistants can make in pursuing professional development and, therefore, “caveat emptor!” With that in mind, here’s the Inside perspective on what you need to know now about professional dental CE and choosing the programs and formats that are right for you, the advancement of your career, and the ultimate well-being of your patients.

The “State” of CE Affairs

Each state board of dentistry—the primary purpose of which is to protect the public—determines what CE credits are acceptable to meet the individual state’s licensure standards. The first state dental board to require CE for relicensure was Minnesota in 1969, notes Neumann.

According to Shragg, all state dental boards outline their conditions for continued licensure within their practice acts, state laws, and/or rules governing the practice of dentistry. These conditions—which may include CE credits earned during a cycle of every one to three years, although South Dakota’s cycle is still five years—ensure that dental professionals maintain competency throughout their careers, he explains.

Similarly, where dentists can earn CE credits from, and in what subject areas, also varies by state. Different state boards approach this aspect differently, Shragg observes, and there are no nationally mandated CE requirements.

“I really think it wouldn’t be a bad idea to have a uniform requirement for dentists,” believes Gerard Kugel, DMD, MS, PhD, associate dean for research at Tufts University School of Dental Medicine. “There could also be some general standards in order for all dentists in the US to receive their license, after which the individual states could add their own specifics if they chose to.”

In Minnesota, a maximum number of credits that can be earned through elective activities (eg, volunteer dental work, teaching, and self study) and applied toward renewal/relicensure has been established, Shragg says. On the other hand, the board has established a minimum number of credit hours that the dental professional needs to earn in fundamental activities (eg, courses where the content deals directly with dentistry, dental hygiene or dental assisting). Minnesota also reviews a clinician’s proof of education in an audit process to determine if the licensee/registrant has met the criteria of acceptable professional development activities and any other requirements of a minimally acceptable portfolio, he says.

Again, the acceptable sources of CE credit are determined by the individual state boards. Organizations, institutes, publications, etc. that provide CE become recognized and/or are considered acceptable by states when they meet specific requirements established by the respective state’s board of dentistry. Many states rely on the Academy of General Dentistry Program Approval for Continuing Education (AGD PACE), as well as the ADA CERP, as indications of a CE provider’s credibility, validity and acceptability.

AGD PACE Providers

Originally called the National Sponsor Approval Program (NSAP), the Program Approval for Continuing Education (PACE) was formed in 1988 by the AGD to help members and the dental profession to identify and participate in quality continuing dental education. The mechanism for approving CE providers is an evaluation of the education processes used in designing, planning and implementing the CE components.2

Currently there are more than 1,000 AGD PACE providers, both nationally and on a state/constituent level, notes Kelly Fox, associate executive director of member programs for the AGD. A list of current providers is available at the AGD Web site under the CE Opportunities icon (www.agd.org).

To be considered for AGD PACE status, prospective CE providers must complete an application, which is available at the AGD’s Web site. Applications are reviewed bi-monthly, beginning in January and continuing every other month thereafter. Approved AGD PACE program providers are expected to adhere to standards covering 14 different areas in order to obtain and then retain their approval status.2

According to Fox, a committee of nine member dentists meets to review applications from organizations that are national or international in scope. The applications are given a score based on the AGD’s scoring system, which determines how many years for which the provider will have approval to provide CE (ie, one to four years). Once that timeframe expires, the provider will need to repeat the approval process, she says.

ADA CERP Providers

To promote the continuous improvement of CE, as well as to provide members and the dental community with a way to select CE programs, the ADA established its ADA CERP in 1993.3 Through an application and review process, a standing committee of the ADA Council on Dental Education and Licensure evaluates and recognizes institutions and organizations that provide CE based on 15 aspects of program quality.

The ADA CERP committee is a group of volunteers that interpret the standards and grant recognition to the CE providers on behalf of the ADA, explains Stiegel. Once approved, CE providers are held accountable for maintaining those standards, and they must seek re-approval every few years.

Currently there are 342 ADA CERP recognized providers at the national level, notes Stiegel, which include more than 50 ADA constituent and component societies and recognized specialties, 70 dental/medical schools, universities, and colleges, and 50 national dental organizations.3 In addition, ADA constituent (state) dental societies and participating specialty organizations are authorized to extend approval to their component (local) societies and affiliates; 97 dental societies are approved through this extended process.3 A list of ADA CERP providers is available at www.ada.org/goto/cerp.

According to Stiegel, of the U.S. licensing jurisdictions that have currently implemented CE requirements for license renewal, all accept credits that are offered by ADA CERP recognized providers. However, that doesn’t mean the state will accept credits in practice management (for example) if that’s a disallowed topic, she points out.

Effectiveness is in the Eyes of the Educated

What makes courses effective learning experiences is dependent upon several factors, not the least of which is the individual attending and/or participating in the educational opportunity (See Some Considerations for Gauging CE Effectiveness & Credibility, page 56). Adults learn best when they have an opportunity to define for themselves what it is they want to learn, explains Ratcliff. And, according to Richard J. Simonsen, DDS, MS, dean of Midwestern University College of Dental Medicine, successful learning is dependent upon what is taught, how it’s taught, who is teaching, and what the objectives are of the person studying.

Who’s teaching is of particular importance to Kugel. Given the vast array of CE centers and institutes that have been introduced, it’s important to be sure that members of these “faculties” have academic credentials (eg, publications, appointments at accredited institutions, etc) that qualify them to teach.

Simonsen says that over the last 10 years, some dental schools have done a good job of taking a leadership role in providing CE; others have not. The growth of some entrepreneurial institutes that are unaccredited (ie, not recognized or approved) has left some dental schools wondering why they didn’t take a more proactive role in planning for CE, particularly hands-on education, he says.

“There doesn’t seem to have been much stimulus for schools to do this, and not very many have gotten into the use of their clinics for hands-on CE,” Simonsen observes. “I think this is unfortunate, and I think this is something that needs to change. I would hope that in the future dental schools would play a much bigger part in providing CE to their alumni and other dentists in their community.”

Some individuals learn best when they have an opportunity to read about a topic, think about it, and then later discuss it. Others are visual learners who need an opportunity to see something either graphically or through live demonstration in order to synthesize or duplicate it. Still others learn by doing.

“However, stand-alone lecture type programs represent the majority of CE opportunities in the US today,” explains Philip Klein, DMD, president and CEO of Learn HealthSci, Inc., a San Diego-based company specializing in advanced instructional design solutions via the Internet and other digital media formats. “In this scenario, what’s critical for creating an effective learning experience is a knowledgeable, energetic speaker who understands how to present relevant material in an organized way.”

“Lecture type CE programs focus on ‘comprehension,’ not ‘competency,’” Klein emphasizes. “Comprehension can be measured accordingly with a post-lecture exam. However, with stand-alone lecture type CE programs, it is difficult to build clinical competency, and it is certainly impossible to measure clinical competency with a standard written post-lecture exam.”

According to Zissi, what makes a CE presentation beneficial is the presenter, the material being covered, and whether the attendee is retaining that information. Therefore, at Tufts, Zissi is in constant contact with his dean and other members of the Tufts faculty when deciding upon whom to invite to Tufts for CE programs.

But there are other CE formats that might be effective and accepted by state boards. According to Klein, research suggests that digital (online) multimedia learning is as effective as traditional classroom events and, in some areas, can provide a better learning experience. Klein adds, “With increased bandwidth, faster computers and technological advancements in Internet-based learning management systems, the Internet will continue to play a greater role in dental CE.” (See Future Perfect: What’s Ahead for CE?, page 58).

“I believe there can be a higher retention rate with Internet-based learning because the student has the ability to access and review the material as a refresher course at anytime, anywhere,” Klein says. “Online courses that incorporate multimedia can also help to improve knowledge retention through advanced, interactive instructional design processes combining voice-over, text and animation.”

Mechanisms for Monitoring CE Opportunities

With the plethora of CE opportunities out there, choosing beyond price and convenience can be a daunting proposition. These are certainly deciding factors, but others should come into play, such as ensuring high quality and unbiased content (See The Indisputable Need for Industry Support, page 60). The good standing of the provider—as well as the instructor—should also be important. The quality and track record of providers recognized by the ADA CERP and/or the AGD PACE are monitored periodically as part of the re-approval process.

Fox notes that the AGD does monitor its providers nationally and through the constituent level, which is why there’s a re-approval process. The previous year’s programs are evaluated to verify that the provider is continuing to operate according to the AGD PACE standards and criteria. What’s more, she says that the PACE program is continually evolving to ensure that approved providers are in fact providing excellent dental education.

“If we receive complaints we will always follow up to ensure that the provider is adhering to our standards,” Fox emphasizes. “The monitoring policy makes it clear how the process works and what the expectations are for the provider and the AGD.”

The ADA CERP also requires a periodic re-evaluation and approval process, Stiegel says. In addition, the ADA CERP maintains an active complaints policy. If a complaint about a CE provider is received, the matter is pursued and the CE provider asked to submit clarification and detailed documentation showing compliance with quality standards, she explains. Providers who do not comply may lose their ADA CERP recognition.

Participation in the ADA CERP and AGD PACE programs is voluntary. Those we spoke to agree that there needs to be some form of baseline standardization in terms of quality control across the multiple and varying CE programs, courses, formats, etc. available.

Simonsen suggests that the educational basis of CE should reside within an accredited institution, such as a dental school, as a form of quality control, not necessarily standardization. He also cautions practitioners about private institutes that “accredit” their course members (i.e., people who come and take their courses); this is not the same as being an accredited institution, he says.

There is no organization in dentistry that provides a “consumer reports” type of evaluation of CE programs. In that regard, monitoring and evaluating CE courses can become a hit-or-miss scenario. Some say the best indicator of the quality of the information and/or the presentation is the person “teaching” the course.

“Conceptually, standardization of the wide range of CE courses available is a nice concept, but I don’t know how that can be accomplished,” explains Yancey. “Somebody would have to establish the baseline for these programs and then revisit all of them to determine if they’re above or below that. That’s hard to put into effect.”

“I think there needs to be some sort of standard established, particularly for some of the surgery type of procedure courses, such as for implants,” believes Jack Dillenberg, DDS, MPH, the inaugural dean of the Arizona School of Dentistry & Oral Health. “Right now the regulations for continuing education are relatively loose in many regards, and teaching a CE course on how to do implants is very different from teaching a course on something less clinical.”

Whether the CE offering is independent, private, academic, or corporately-sponsored, it should be held to a standard that, in the end, will help improve the health care of the public and, secondarily, improve the economic viability of the dentist’s practice, notes Simonsen. Both of these goals can be accomplished without compromising the ethical standards that all dentists must adhere to, he says.

Conclusion

The consensus is that it’s almost impossible these days for dentists to survive and be good health care professionals without taking advanced courses on an on-going basis. The information and skills they acquire by doing so can’t be taught currently in the four-year dental school curriculum, many agree.

“This doesn’t mean that dental schools are remiss in their duties,” Yancey emphasizes. “It just means it cannot be done.”

Rather, Simonsen suggests that the first lesson any dental student should learn is that the first day of dental school is simply the first day of dental education. That education, he says, should continue over the course of their professional lives.

After all, the landscape of dentistry is changing almost daily. Education is the vehicle empowering dentists to confidently travel over new terrain—and take their patients along for a safe and healthful journey.

Therefore, the main goal of a CE provider should be to keep dentists abreast of new developments in the profession. The goal of dental professionals pursuing CE credit should be to become lifelong learners.

“I heard it my first day in dental school: learning is a lifelong process,” recalls Ratcliff. “Those who really believe that and take advantage of all of the quality learning opportunities out there are the ones who are going to love dentistry and flourish.”

1 Based on 2003 data reported by the American Dental Association in 2004; supplied by Laura M. Neumann, DDS, MPH.

2 www.agd.org/cde/pace

SIDEBAR 1

Who Needs What & What’s the Cost?
Costs for dental continuing education (CE) are trending both ways; what you spend depends on where you go and what you take. Steve Ratcliff, DDS, from The Pankey Institute, has witnessed an increase in the number of low cost CE options available, such as Internet learning and education through trade and association journals. There are also Web casts that are available on a subscription basis, as well as high-quality DVDs that enable dentists to learn at home using their computers. On the other hand, he notes that there are programs at many institutes around the country where the cost of engaging in significant continuing education is very high compared to other formats.

But overall, many believe the costs are going down because there are more affordable options available, and many of these are subsidized by industry. Some CE courses are even free, although some are nothing more than glorified sales pitches.

“I think that dentists know a quality CE program from an infomercial and, in the long run, the quality CE providers will be recognized by the dental profession,” observes Philip Klein, CEO of Learn HealthSci, Inc.

Comparatively speaking, what’s required of dentistry is no different than what’s required of other technique and device/medication driven professions. However, dentistry’s CE model doesn’t follow medicine’s accreditation model (ie, dentistry recognizes, it doesn’t accredit, its CE providers).

“I think it is very similar,” believes Laura M. Neumann, DDS, MPH, from the ADA. “We usually compare dentistry to medicine, nursing, and pharmacy, which also have professional licensure; the regulation of those health professionals is all under state jurisdiction, and most of them have some requirement for mandatory CE for relicensure.”

William R. Yancey, DDS, the assistant dean and director of continuing dental education and alumni affairs at UCLA School of Dentistry, says that what’s required for dental CE is fairly similar to what’s required for other health care professionals. In fact, his program has conducted joint CE courses with the UCLA Continuing Medical Education (CME) partners in which there was a common thread for both MDs and DDSs/DMDs.

“We [dental and medical professionals] seem to have similar goals and similar kinds of requirements,” Yancey observes. “Physicians are doing the same things we are—they have requirements, they’re going to courses.”

SIDEBAR 2

Some Considerations for Gauging CE Effectiveness & Credibility

You most likely spend a nice chunk of change to attend continuing education (CE) programs, in addition to taking time away from your practice in order to fit the coursework into your schedule. Both simultaneously translate into more money out of your pocket. Therefore, you’re likely choosing CE programs carefully based on topics covered, location, providers, instructors, and a host of other factors. When pursuing CE, savvy dentists will also balance their schedules with courses that are wanted, as well as those that are needed.

To help increase the likelihood that what you select will satisfy your needs, we’ve put together a checklist of the top recommendations suggested by our experts. Combined, they’ll help ensure you get everything out of the experience that you’re looking for.

1. Hands-on Components.
Jack Dillenberg, DDS, MPH, the inaugural dean of the Arizona School of Dentistry & Oral Health, notes that dentists are very active in nature. “I believe that as they learn the concepts that are related to an actual mouth, tooth, or person, students will learn the information better in a hands-on experience, rather than having it presented in a lecture format,” he says.

What’s more, William R. Yancey, DDS, from the UCLA School of Dentistry, says that if dentists are only learning a new technique by reading an article, one of two things can happen. “Number one, they’ll end up experimenting on their patient because nobody really showed them how to do it,” he says. “Or number two, they’ll just never try it because it is almost impossible to gather enough information from an article to actually change your behavior or change to a new concept in dentistry.”

Simple procedures can be learned without the hands-on component (ie, reading and/or lectures), clarifies Richard J. Simonsen, DDS, MS, dean of Midwestern University College of Dental Medicine. However, the hands-on component is an important part of the learning process, which is why dental schools are equipped with clinics for hands-on instruction; without a clinic or simulation experiences, students can’t learn clinical procedures as well, he says.

According to Philip Klein, DMD, president and CEO of Learn HealthSci, Inc., CE programs that offer a hands-on component provide a more engaging and memorable learning experience for the student. In this scenario, he says, students have a better opportunity to learn as a function of greater interaction with the instructor and other students, as well as simply by getting their hands dirty with various dental instruments, supplies and dentoforms. “These kinds of programs focus on comprehension and competency and have the dual ability to measure both,” Klein says.

2. Relevant & Proven Information.
Steve Ratcliff, DDS, from The Pankey Institute, says that when dentists are evaluating what types of CE endeavors they want to participate in, they should ask the following questions, “What is it I need most right now?” and “Is there something I can learn that is going to enhance my practice or my effectiveness with my patients?” Relevancy of the subject matter—either to the practitioner personally or in terms of what is timely—is important.

But, notes Marshall Shragg, MPH, president of the American Association of Dental Administrators, it’s important for attendees and instructors to ensure that information about procedures, products, and any other subject matter discussed is appropriate for the providers attending a CE program in a given state. “This can be a significant concern when delegation of duties, levels of supervision, and required training levels are different across the states,” he says. “An example is the use of lasers by dental hygienists, which raises questions similar to those that come up with other new technologies: can the dentist, hygienist, or assistant legally use this technology and what training does the state require?”

What’s more, as he’s noted previously in Inside Dentistry, Gerard Kugel, DMD, MS, PhD, from Tufts University School of Dental Medicine, emphasizes the need for CE content to have evidence of its validity (ie, research-based support). “What makes for an effective learning experience depends upon what your needs are,” Kugel says, “but the information contained in the CE program must be based on some evidence that it works or some type of clinical relevance.”

3. Clearly Defined Learning Objectives.
Marsha Stiegel from the ADA says that learning objectives for CE programs should be clearly outlined so that participants know going into a course what they should gain by the end of it.

4. Personal Interaction with Instructors/Peers.
“Dentists, because they work alone, will many times choose to take CE at an on-site location so they have a chance to talk to other dentists and health professionals,” believes Laura M. Neumann, DDS, MPH, from the ADA. “By doing so they are able to discuss the content and compare notes. This might be most valuable to understanding how whatever information they are studying or learning can be useful in the context of their own practices.”

Yancey adds that a CE participant’s ability to follow-up with the instructor afterwards to ask questions and/or troubleshoot to determine why something might not have worked for them goes hand-in-hand with the on-going CE process. “CE participants need support,” he says.

5. Meets State Requirements.
Go online to your state’s board of dentistry Web site and review its criteria and CE requirements. Be sure that you’re signing up for and receiving credits in areas that you need. Check limits for the number of credits that can be received in a given subject area and from what formats (eg, publications, online, home study, etc), and verify auditing procedures, if applicable.

6. Solid and Reputable Credentials of Instructor(s).
“We carefully evaluate a speaker’s Curriculum Vitae, expertise in his or her designated field, and performances at other CE venues,” explains Vangel R. Zissi, DMD, from Tufts University School of Dental Medicine.

Stiegel adds that instructors certainly need to be appropriately qualified to teach dentists, which is basically having additional credentials beyond the dental degree, such as specialty training, additional graduate degrees, or other evidence of peer-reviewed expertise.

Kugel says that for hands-on courses to be effective, it’s important that the instructor is experienced with the use of the materials and/or techniques being demonstrated. “I would like to see more people with some advanced training; people who can actually conduct CE courses on topics about which they’ve actually done some clinical work or field research,” he says.

7. Honest Disclosure.
If there is a conflict of interest between a material device company and the speaker/author/instructor (ie, a relationship), dentists attending and/or participating in the CE experience have a right to know and, therefore, the relationship must be disclosed, says Stiegel. “We believe that the dentist has a right to know and be able to process who the speaker is, as well as whether or not he or she has an independent view or relationship with the materials and devices that they may talk about,” she notes.

What’s more, complete disclosure of corporate/industry sponsorship of a CE program is essential so that clinicians can best determine whether or not they want to attend/participate based on perceived or anticipated bias.

SIDEBAR 3

Future Perfect: What’s Ahead for CE?

Continuing education (CE) at dental schools is going strong, but an obstacle they face is competition—not only from other schools, but also from dental associations, trade shows, on-line courses, and other types of providers. Dentists who are mandated by law to acquire CE credits have many options for obtaining them, explains Vangel R. Zissi DMD, director of the division of continuing education at Tufts University School of Dental Medicine, and most dentists look for a legitimate, fast, and inexpensive way to meet their requirements.

“It is my hope that alums, recent graduates and seasoned practitioners will continue to see the value of obtaining CE in a classroom setting and the importance that it has on their careers,” Zissi shares. “I am optimistic that CE [at dental schools] will grow and continue to play a large role in the field of dentistry.”

As a result of competition among CE providers, the ADA’s Laura Neumann suggests that those CE providers that want an advantage will seek out recognition from ADA CERP and/or AGD PACE in order to have “a stamp of perceived quality.” She predicts that dentistry will see an increase in the number and type of providers that want to be certified and/or recognized by either or both organizations.

“In general there is more demand for accountability from health care institutions,” Neumann elaborates. “As a carry-over from what’s taking place in medicine, we’re seeing dental professionals become cautious about who’s providing the education and what the potential conflicts could be, so I think there will be more emphasis on formal standardization of quality through recognition programs that have criteria to deter people from providing CE that is biased or unscientific.”

Jack Dillenberg, DDS, MPH, the dean of the Arizona School of Dentistry & Oral Health, says that translating new science into meaningful practice can best be handled by dental schools. Such institutions can be fair witnesses and impartial, unbiased presenters of the facts, unlike some “educational” companies that have vested interests in making profits or promoting a specific philosophy.

However, dental schools are still faced with the same dilemma Inside Dentistry first reported last year—recruiting good dental educators qualified to both lecture and provide clinical, hands-on instruction, explains Gerard Kugel, DMD, MS, PhD, from Tufts University School of Dental Medicine. In some cases, he says, in order to find individuals who can balance clinical practice, teaching, and materials/science knowledge, dental schools may need to partner with private institutes in order to bring CE back under their control (eg, The Rosenfeld Institute based at NYU Dental School or the Craniofacial Esthetics Institute at Tufts University).

In terms of future alternative formats for CE, Steve Ratcliff, DDS, from The Pankey Institute, believes that nothing will compare to the effectiveness of hands-on, experiential small group learning, but he does see the potential of the digital age. In fact, technology may actually enable new ways of providing experiential teaching, he suggests. For instance, perhaps a master clinician could provide content that is “beamed” to any number of sites at which there would be mentor instructors who could then facilitate small group exercises based on the Web cast.

“In the future there will be a lot of opportunities for different kinds of learning, although I don’t know if the basic concepts would change,” Ratcliff postulates.

Philip Klein, DMD, the CEO of Learn HealthSci, Inc., predicts that the future of dental CE is the Internet, based on the many advantages (eg, anytime, anywhere learning; paperless CE credit management) it can provide. Although still in its formative stages, online training offers the possibility of accessing 3D software that can simulate clinical procedures, Klein says.

“To give you an idea of the current trend in online CE, in 2000 we had approximately 275 dentists sign up for one or more of our online CE courses, with only 2,400 dentists visiting our Web site that year,” Klein recalls. “Compare that to 2005, when we had more than 9,000 CE accounts with over 147,000 unique visits. These numbers tell me that, more and more, dentists are looking to the Internet for CE.”

Dillenberg envisions a day when lecture or demonstration type CE may be delivered through Pod casts or modalities other than what educators have been using traditionally. In this scenario, a dentist wouldn’t necessarily “have to be there” if he or she wanted CE.

“I would think that if a dentist wanted CE, he or she could go to a Web site, download content, and then view the presentation on an iPod type of device at their own pace, on their own time,” Dillenberg imagines. “I think this is where the future will be.”

SIDEBAR 4

The Indisputable Need for Industry Support
It’s well known that some of the research at dental schools is directly tied to industry. This stimulates product development and can improve the standard of dental care in the US, believes Philip Klein, CEO of Learn HealthSci, Inc.

“The same applies to continuing education (CE),” he says. “The dental profession needs to know, on a continual basis, about new developments that can potentially improve the way dentistry is practiced. Industry has the ability to provide CE that can facilitate this knowledge transfer.”

Kelly Fox from the AGD agrees, noting that the role of industry in providing CE is an important one. “Dental technology is continually changing, pretty much on a daily basis,” she observes. “So, there is a lot of CE that is needed to help dental professionals learn new techniques and stay up-to-date within the profession.”

Industry sponsored CE is prevalent throughout the “medical” sector of health care and will likely continue to play an important role in the dental arena, also. Some say an important consideration is that the CE program—regardless of its format—should not be product driven. Rather, it should be educational and informative, exposing dental professionals to new developments that may be useful to their practices and beneficial to their patients.

Steve Ratcliff, DDS, from The Pankey Institute, says that there are some very ethical members of industry who do their best to bring current information to the marketplace based on the independent research that’s been conducted. When industry CE is strictly about one product, that misses the mark ethically, he says.

“The big players in the industry have done an outstanding job of maintaining their integrity by offering quality CE to the profession,” Klein says. “Many of these companies have hired CE directors that specialize in education and are directly responsible for maintaining the ADA CERP and/or AGD PACE guidelines that govern dental continuing education.”

Fox explains that when working with “industry” CE providers, the AGD PACE committee refers back to its program guidelines to ensure that courses sponsored by dental businesses have a scientific basis. “We really feel they should be about learning and focus primarily on the educational aspect of the CE experience,” she says.

The ADA CERP program guidelines have similar requirements. Additionally, those guidelines apply equally to all CE providers, whether industry related, academic or private institutes.

According to Vangel R. Zissi, DMD, from Tufts University School of Dental Medicine, even corporately sponsored vacation CE courses are no less effective than courses given at a teaching institution as long as the presentation is beneficial to attendees (ie, good material, presenter, information is retained).

Richard J. Simonsen, DDS, MS, the dean of Midwestern University College of Dental Medicine, does not necessarily agree that industry-sponsored CE should not be product-related. In fact, he argues that this should be the primary focus of such CE programs, “since who can better teach how to use a new material than the company that produced it?” He continues that industry-supported CE, unless in the form of a genuine unrestricted educational grant, is always going to support the industry sales strategy, “so why try to hide this fact behind the veneer of ‘scientific balance?’”

When industry members partner with dental schools for CE, such arrangements work best when companies allow the CE department of the school to select, deliver and control the content, explains William R. Yancey, DDS, from the UCLA School of Dentistry. Also, if the school needs specific types of materials and members of industry could provide them (eg, for hands-on courses), such an arrangement is also beneficial.

When it comes to CE and corporate sponsorship, Gerard Kugel, DMD, MS, PhD, from Tufts University School of Dental Medicine, says dental schools are always in an awkward position. Most schools are reluctant to accept money from companies in support of specific courses.

“They’d rather accept an unrestricted educational grant to the school,” Kugel explains. Similar to what Yancey describes, these grants would ensure that the dental school maintains control of the content and choice of instructors.

“It’s a bit sketchier when industry is running its own courses,” Yancey says. “Some companies conduct pure CE courses, but some offer just infomercials.”

SIDEBAR 5

The Inside Look From...

Since our inaugural issue one year ago in October 2005, all of us at Inside Dentistry have been striving to deliver clear, objective, and relevant reporting of the issues that face the general oral health care profession. The publishers and staff gratefully acknowledge the following individuals, without whom this Inside look at continuing education for the dental profession would not have been possible. Their candid comments and professional insights were invaluable to developing a comprehensive and timely presentation.

Recognition Associations

Kelly Fox
Associate Executive Director of Member Program
Academy of General Dentistry
Kelly.Fox@agd.org

Laura M. Neumann, DDS, MPH
Associate Executive Director, Division of Education
American Dental Association
neumannL@ada.org

Marsha Stiegel
Manager, ADA CERP
American Dental Association
stiegelm@ada.org

State Board Representatives

Marshall Shragg, MPH
Executive Director, Minnesota Board of Dentistry
President, American Association of Dental Administrators (AADA)
Marshall.Shragg@state.mn.us

Dental Schools

Jack Dillenberg, DDS, MPH
Inaugural Dean
Arizona School of Dentistry & Oral Health
jdillenberg@atsu.edu

Gerard Kugel, DMD, MS, PhD
Associate Dean for Research
Tufts University School of Dental Medicine
gerard.kugel@tufts.edu

Richard J. Simonsen, DDS, MS
Dean
Midwestern University College of Dental Medicine
rsimon@midwestern.edu

William R. Yancey, DDS
Assistant Dean & Director of Continuing Dental Education and Alumni Affairs
University of California Los Angeles School of Dentistry
byancey@dent.ucla.edu

Vangel R. Zissi, DMD
Director, Division of Continuing Education
Clinical Professor of Endodontics
Tufts University School of Dental Medicine
vangel.zissi@tufts.edu

Content Developers

Philip Klein, DMD
President & Chief Executive Officer
Learn HealthSci, Inc.
pklein@dentrek.com

Private Institutes

Steve Ratcliff, DDS
Director of Academic Affairs
The Pankey Institute for Advanced Dental Education
sratcliff@pankey.org