November/December 2010, Volume 6, Issue 10
Published by AEGIS Communications
A Conversation with Harold C. Slavkin, DDS
The university dean and former director of the NIDCR talks about the challenges facing dentistry, dental research, and the delivery of dental healthcare.
INSIDE DENTISTRY (ID): Dr. Slavkin, you have had a number of unique positions within the profession, including dean of a dental school and head of the National Institute of Dental and Craniofacial Research (NIDCR). Could you tell us about those roles you’ve filled throughout your career? For example, what led you to a career in dentistry in the first place?
HAROLD SLAVKIN (HS): Well, after I graduated from high school in 1955, I enlisted in the Army and was trained to be a dental technician at Fort Sam Houston by Dr. Henry Sutro. Henry was a fantastic mentor and role model who encouraged me to consider going to dental school after the Army. As a dental technician stationed at Forest Glen, Maryland (connected to Walter Reed Hospital), I was assigned to fabricating prostheses for facial burn patients. I was motivated to complete undergraduate studies in English literature and then go to dental school—I did both at USC in Los Angeles. These were critical stages in my journey into dentistry.
As a dental student, I collaborated with other students on research; I attended several IADR meetings and upon graduation in 1965, I practiced part-time as a general dentist in Westwood Village, while I pursued a postdoctoral fellowship. I joined the full-time faculty at USC in July 1968. By this stage, I was dedicated to a career in academic dentistry with a focus on “nucleic acid biochemistry” as related to the head, face, mouth, and teeth—“craniofacial-oral-dental research.”
A year later, in 1969, I was asked to become the chairman for the Department of Biochemistry and Nutrition in the dental school, and I served in this capacity for 6 years. In 1975, I took a leave of absence to serve as acting lab chief in the laboratory for Developmental Biology at the National Institute of Dental Research (NIDR) in Bethesda. I loved working and learning at the National Institutes of Health (NIH)—this was a superb experience.
Upon my return to USC, I worked with other faculty to create a new graduate program called “craniofacial biology”—an attempt to foster multidisciplinary research revolving around the critical questions of craniofacial birth defects, head-and-neck cancer, and head and neck trauma. Working with graduate and postdoctoral fellow students and through a broad array of scientific and international collaborations, I pursued studies to understand how teeth are formed, how enamel, dentin, and cementum are formed, what are the key genes involved in human craniofacial anomalies, and a host of other challenging problems. During this period I served as laboratory chief and director for the Laboratory for Developmental Biology in the Gerontology Center at USC (1972–1988), and then as the director for the Center for Craniofacial Molecular Biology (CCMB) from 1989–1995.
In 1995, I was recruited to become the sixth director of the NIDR, serving through June 2000—and I discovered that being in the right place at the right time can be enormously important. This was an incredible experience, rich in opportunities to influence research policy and enhance the reputation of “dental research” within the fabric of biomedical research. During this period, we worked to instill strategic planning, collaboration, and cooperation between all stakeholders (dentists, dental hygienists, physicians, nurses, pharmacists, biomedical scientists, health professions educators, patient advocacy groups, journalists, and Congress). I was blessed with a remarkable staff and with enormous support from my wife Lois.
During this time, working closely with ADA leadership, we were able to change the name of the NIDR to NIDCR, a name that more accurately reflected the depth and breadth of our work. We fostered research on oral health disparities, craniofacial birth defects, oral and pharyngeal cancer, innovations in biomaterials, and saliva as a diagnostic, as well as focusing attention on oral–systemic diseases, training, and collaborations with other Institutes. We were invited to serve as the lead agency for the first Surgeon Generals’ Report Oral Health in America.
In August 2000, I officially returned to my alma mater to serve as the 11th dean of the USC School of Dentistry (2000–2008). As we worked closely with students, staff, faculty, alumni, and friends, it became evident that we needed to look beyond the walls of the dental school and become fully aligned with our parent university. At the same time, we needed to foster “student-centered learning” approaches within dental education, develop and expand lifelong learning through CE programs, update equipment and physical clinical resources, and advance a state-of-the-art practice to retain gifted faculty—while remaining focused on the “fundraising” that enabled these changes.
I returned to the University in January 2010 as a tenured professor engaged in research, teaching, and writings.
ID: When you were trained to be a dental technician, how was your aptitude identified, because otherwise it seems to me you would have gone a completely different route?
HS: Yes, I know. I think for me a lot of these roles were sort of accidents, when certain very impressive people arrived at critical junctions in my life—a young person’s life. I was coming out of high school at 17 years old—really not academic and not thinking of the university—and a friend’s father suggested going into the Regular Army as a volunteer. I got permission from my parents and randomly chose between being a medic or a dental technician. Dental tech took longer, so I thought that was the better choice—that’s how I started. Then I realized that after the Army I could moonlight and pay my way through college and dental school. So I did dental technology for probably 8 years.
ID: But you were an English literature major as an undergraduate—we do not see that very often in dental students.
HS: It was suggested to me that dentistry would be a highly focused field, and so I really needed to get a broad liberal arts background, because I would never get that again. That was the coaching that I received, and I took that advice. I thought that I would like it very much, but it also seemed that before focusing on the mouth, it would be wonderful to play with some of the big ideas.
ID: When you started doing research as a student, was that simply to earn some money, like a work study program?
HS: No, it was patient-driven. I was assisting in the clinic, and they were discussing a second division block of the trigeminal. I had never heard of that, and there were no guidelines about where you put the needle, how far it goes in, and what the consequences are if you do not do it right. So I joined a couple of other dental students, and we invented a project and got a little grant from the dental school to get it off the ground.
Later a patient with amputation neuroma came in, and I had never heard of that before. So I teamed up with the head of our oral surgery department to do a case study.
ID: Looking back on these experiences, were there any surprises?
HS: I am greeted everyday with surprises! No two days are exactly the same. Life and living offer “teaching moments” everyday. I have come to believe that almost anything is possible; that change and being a change agent almost always comes with resistance and “push-back”; that learning for me is living (and living is learning); that my wife is my best friend; that children, grandchildren, and family are enormously important; that nurturing and mentoring are profoundly essential at any age; and that one’s own health should never be taken for granted.
ID: Can you compare the ins and outs of running a large governmental research agency and running a dental school—which of those two jobs was harder?
HS: In a sense, my training allowed me to adapt to the federal agency—for example, the kinds of people who were leading the other Institutes, and the mindset at the NIH that all of the boats rise with increased funding (not in the same proportion, but they all rise). Harold Varmus as the leader had a very collegiate mix of people; it was very easy on many levels to adapt to that.
Ironically, being a dentist, and having been a dental technician and practiced in the private sector—the dental school was more difficult. Gaining consensus was much more difficult, the needs of the students as they perceived them were very different from the faculty, the differences between faculty backgrounds was enormous, the whole issue of paying the bills in a private school, and raising millions of dollars a year—it was more challenging for me.
ID: So did your job become one of a broader fundraiser?
HS: Yes. I raised much more money at the NIH, but the way you do it is very different. You raise it through your involvement with the Senate and the House and with other institute directors, and so the game is very different. Consuming lots of rubber chicken, raising millions of dollars—but doing it when it is $5,000, $2,000, or $25,000 gifts—it takes a long time to get to $3 or $4 million dollars a year.
ID: As someone who is steeped in research and academia, were you able to spend as much time at the school on scholarly concerns, as you did on administering and fundraising and other aspects?
HS: In a private school, especially one such as USC, fundraising is critical to the survival or growth of the school. It is a must, it is basically a seven-day-a-week commitment. You are out there almost 24 hours a day, meeting and asking people, sort of with a tin cup, with good intentions. It is a very consuming activity, and after 8.5 years, I got a good dose of it. Today I really appreciate not only that the private schools, but also the public schools have to do the same thing. Much of it relies on deans and other leaders in dental schools to really let programs drive the fundraising. Most people do not donate to fix something that is broken, rather they donate because they are excited about a program. Some of the marketing is really derived from the interests of students and faculty, and you need to be pretty effective in communicating that to a very disparate population of people called alumni and friends.
ID: Regarding the discipline of craniofacial biology—it is fascinating the way that concept began, asking questions about birth defects and cancers. What is the state of the art of this discipline today?
HS: It has come a long way. By the way, the person who really gave birth to the term was at the University of Illinois in Chicago in 1964—Sam Pruzansky, an orthodontist with a very “big picture” mentality. At that time, it was a whole new way of talking.
Today, we are talking about hundreds of millions of dollars in research, craniofacial teams all over the country, craniofacial surgeons (a formal subspecialty of plastic)—it has really advanced to a very mature, sophisticated way of looking at this discipline.
ID: What are some of the cutting-edge research elements that are going on in craniofacial biology these days?
HS: Transplanting the human face, which was done a couple of years ago in Germany for the first time—that has moved very quickly. Some very new ideas include using a medication, a therapeutic of a new molecule that has been put together to eliminate the signs of a disorder called anhidrotic ectodermal dysplasia. That went from discovery of the gene to animal studies and now the FDA has approved Phase I clinical trials.
ID: That is probably one of the better examples for our general-practitioner readers, who often ask when research is going to hit chairside and they can do something with it.
HS: Ectodermal dysplasia is not commonplace, but it is not that rare. These children are born with either no teeth or misshapen teeth, they are unable to perspire, they have a very difficult time tearing out of the lacrimal duct. Their skin is albino, and their hair is very thin. What is amazing is that you can treat a pregnant mother who is carrying such an embryo/fetus, and the child will be born with none of these defects. And that is sort of miraculous, counterintuitive. Today, patients born with ectodermal dysplasia face a lifetime of dentures and implants, and it is not the most satisfying for the patients. I think clinicians have been waiting for something to happen that might make life a little simpler, and now it is on the horizon.
ID: What other dental diseases would you say are close to that same threshold of understanding?
HS: The so-called biomarkers for periodontal disease, interleukins, have come a long way in the ability to identify who is at risk or to be able to see by changes in the biomarkers if there is legitimate improvement after therapy. All of the diagnostics for head-and-neck birth defects are now gene-based. In addition, saliva as an informative fluid has changed from something we struggled with to keep a dry field to a pond of information that tells us an enormous amount about a patient. That is breaking and could become a whole new field for practicing dentists—being able to use saliva almost like physicians have historically used a sampling of blood and urine should be very, very powerful.
ID: Do you think salivary diagnostics will be mainstream in private practice in 5 years?
HS: Easily. David Wong out at UCLA and Daniel Malamud at NYU—there are a number of people around the country working on this. In November, there is going to be a conference showing the state-of-the-art in Arlington, Virginia. Proof of principle has been established—the list of what you can do with the diagnostics is growing. It is really quite remarkable, and it is going to be a situation that the dental profession will have to “use it or lose it”—because internal medicine, pediatrics, ob-gyn, family medicine, and primary care can easily pick it up and run with it, if dentistry decides to pass.
ID: Will this bring dentistry and medicine closer together?
HS: It could. When you talk diagnostic codes and in the same language, and you develop similar counseling techniques—it should bring the fields much closer together. I would hope so.
ID: What has been the most significant change that you have witnessed in the profession in the last 25 years?
HS: The digital revolution has made enormous strides to enhance the profession of dentistry in many ways, such as the electronic patient record, digital radiography, digital intraoral photography, and computer-assisted design and fabrication for operative and restorative dentistry (CAD/CAM). In addition, enormous opportunities have evolved between dentistry, medicine, pharmacy, and nursing, along with an appreciation that the mouth is connected to the rest of the body.
In my opinion, it is quite sobering to realize that almost one third of the American population has little or no access to oral healthcare, especially poor children and the elderly. I am also dismayed by the seeming movement away from “science as a way of knowing” to trendy and often not proven procedures and materials in dentistry. I sense a significant increase in the “commercialization” of the dental profession. Of course, these are complex issues, often without simple solutions.
ID: From your perspective, what are the biggest challenges you see facing dentistry in the next 5 to 10 years?
HS: We are at a “crossroad” of sorts. Can and should dental education be provided within research-intensive universities? Can we identify, nurture, and instruct the educators and researchers of tomorrow? Can we (somehow) reduce or control the enormous costs of dental education (the most expensive education program in the university)? In my opinion, we need a 21st-century Gies Report that provides a roadmap for the future of dental education.
We have a national shortage of full-time faculty, educated and trained for this century. We have a profound shortage of dentally educated researchers capable of competing for peer-reviewed grants. If we are not able to act now during this crisis in dental education, our future will not be as a learned profession among other learned professions within research-intensive universities.
For example, “doctorate degrees” are earned by dentists, pharmacists, optometrists, and physical therapists. In universities, schools of dentistry and pharmacy persist; optometry education has increasingly become the function of proprietary schools. PT is often a “program” in the university. There seems to be a well-understood distinction, for example, between the ophthalmologist (a specialty of medicine), the optometrist, and the optician. There seems to be some level of controversy about the DDS or DMD being “an ophthalmologist-like model” or an “optometrist-like model.” This concerns me.
ID: In your view, what would a 21st-century Gies Report do, and how would you suggest that the profession look at it? Is there something that needs to be looked at more carefully?
HS: The answer would be yes. If one goes back and reads the Gies Report—it is vintage 1920s, so the expectation would be that it would be coded with old-fashioned thinking. The irony is that you could change the numbers, and if it were coming out today, it would be considered futuristic. We never lived up to the Gies Report. We grew dental schools and affiliated with universities rather well—we got off to a pretty good start, but the depression was in the way and then World War II.
Finally when that was cleared away, the ADA lobbied hard to create the NIDR, and the first director, H. Trendley Dean, went out begging the dental schools to develop faculty who would be competitive, get NIH funding, and do that level of scholarship. Since then, every director of the NIDR (later the NIDCR) continues to beg—however, today in the 21st century, we are running out of dental schools that have a scholarly component in their mission statement. We are doing very well at training dentists for today; we are less effective in the investment in lifelong learning and looking into the future. We are failing to produce a 21st century faculty with all the bells and whistles that it needs for dental schools to belong to major research-intensive universities.
My feeling is that there is a fork in the road: some of the dental schools are going to go in one direction, which is pragmatic thinking about the cost of dental education and focusing on meeting the needs of today without research; while a very small percent of the schools, maybe 20% at the most, are going to work toward being research-intensive.
ID: Are you urging leaders to go back and re-read the Gies Report?
HS: Absolutely re-read it. There was also a 1995 report called Dental Education at the Crossroads, with Institute of Medicine recommendations. Then the ADA came out with The Future of Dentistry, in 2001 or 2002. So groups of people have thought about this and have made recommendations—but the recommendations have not translated into reality.
ID: Back in the 1960s and 1970s, we went to the federal government to get capitation money to build dental schools. But it does not seem as though there is a lot of money in the system these days for growth and expansion and new construction.
HS: Unless it is program-driven. I do not pretend to know for sure, but one of my guesses is that the baby boomers, which represents 78 million people who are eventually going to be turning 65—they are going to believe that Medicare comes with oral healthcare, and it does not. And they are going to be shocked that by not saving a large sum of money, they are going to be unable to make copayments for looking after their mouths in their retirement. And they will become very vociferous in asking government to change that. If you start thinking about how many people access oral healthcare today and how many Americans there actually are who could be accessing oral healthcare—it could grow by 30%. I would argue that we probably do not have the capacity to deliver comprehensive oral healthcare to 320 million Americans.
ID: That was a debate during healthcare reform—depending on the nature and the extent to which coverage is included (whether it is medicine or dentistry), do we have enough providers?
HS: At the moment, the AAMC (the medical equivalent of ADEA) is really pushing the envelope—they just got a very large grant from HRSA to introduce oral health curriculum in the medical school curriculum, with the idea that there is a large array of preventive services that physicians and physician–nurses should be able to deliver.
ID: That brings up the medical model of delivering dental care—moving away from surgical steel, toward medicaments and the kinds of therapies that physicians use. So do you see the physician community delivering a lot of oral healthcare in the future?
HS: On the preventive side. I think that there would be no ambition on the part of the medical community to learn how to do porcelain onlays. Some on the surgical side would easily do dental implants, but I think a lot of the prosthetic solutions would still be in the hands of people who call themselves dentists. But there is an awful lot of fluoride varnishes, sealants, and new therapeutic solutions to periodontal disease that could easily be done under the supervision of medically trained people.
ID: It seems as though diagnostics are moving more toward that understanding or a risk-based approach, the ability to catch things in a different, preventive way—which seems to fit with that model?
HS: By analogy, there does not seem to be conflict between an ophthalmologist, who is dealing with cataracts and glaucoma and various serious diseases that affect vision, and an optometrist, who is designing and fabricating either contact lenses or conventional glasses. They both get a doctorate, but they are not confused where one begins and where the other begins. I think in our profession—and again this is pure fantasy—I feel that there is a bifurcation between dental education where we are trying to train ophthalmology-like people as opposed to optometry people in the name of dental education. And I think it is going to fracture along some plane that will segment those—one segment will become absorbed in the medicine, as a specialty perhaps, while the other will prevail as a doctorate-level profession, like optometry. But when you think about optometry, most of the schools of optometry are not affiliated with a research-intensive university, most of them are free-standing. And pharmacy is going through this—schools of pharmacy have become proprietary. There are a small number that are scholarly, but the majority of schools of pharmacy are very pragmatic, very much about the needs of today. There is an opportunity for some fresh thinking—rather than being pulled into one of these compartments, maybe to try to shape the future.
ID: So you see some models out there that could help dental leaders understand different delivery systems as well as historical patterns?
HS: Exactly. The two that I would recommend would be looking at the history of optometry—past, present, and future—and the same for pharmacy. I think there are a lot of lessons to be learned, and then maybe we can come up with yet another version that would make sense for the future of the oral health profession.
ID: What advice are you giving today’s graduating dental students, and is it different from what you have given in the past? If you had a son or daughter contemplating dental school, what would you recommend for them?
HS: My advice has always been “follow your passion.” I still offer the same advice for my children and grandchildren as well as university students and friends.
ID: What do you hear from students these days? What concerns them the most about dentistry?
HS: I think as people get older, sometimes they become overly critical of the “young people,” and I do not want to fall into that age-restricted way of thinking. In the dental schools that I am most familiar with—which are mostly on the west coast but I have been in and out of all of them over the years—the students are very pragmatic. They want to be their own boss; they want to make a very good living; they want to work as many days as they wish. They have an aversion to risk; they want guarantees. They are remarkably gifted in the use of information technology and multitasking. But they struggle with staying focused, and managing time seems to be unusually hard for the modern-day student, much more difficult than 20, 30, 40 years ago. They have an enormous capacity, but they are very into the money thing, and the protection of being part of a monopoly.
ID: There seems to be a conflict there—you said students want to be their own boss, but they have an aversion to risk.
HS: Right. Their take is that dentists are not overly regulated, and if you move into a community with a sufficiently large population of middle and upper middle class people, you will do just fine. And they do not see that as a risk. They cover their bets by not going immediately into private practice—they do an associateship to temper the risk, or they work in a clinic for 2 to 4 years until they have the confidence to become a private practitioner.
ID: How many of these students want to be researchers?
HS: My experience is 1 in 100 would be an enormous number. In medicine, 30 or 40 years ago, somebody decided that they would recruit MD, PhDs directly out of college, and the grants they received would cover their medical education as well as their PhD. And they would network those people and nurture them for the whole duration. That program has yielded 70% retention into academic biomedical sciences, while dentistry’s retention rate is probably less than 20%. We tend to recruit in the senior year, when people have already made a huge investment and have already focused on the reason they went to dental school—which was to practice dentistry, not to get a PhD or be an academic.
I think we recruit too late, and we give too little in support. In my generation, many of us thought that academics was far more interesting than going to Vietnam. We were referred to as yellow berets, because we elected to go into academics. Today we do not have the equivalent of a national draft, a requirement to serve, or something like Vietnam—so that kind of assistance is gone. And because we live in a capitalistic country, young people have accrued debt for their college and dental education—and what we give is peanuts compared to what they can get in the private sector. So it is not a level playing field—it is a very distorted playing field.
ID: When you look in that crystal ball for the profession, what do you see? New research findings, practice concepts, materials? Where is tomorrow’s frontier for the profession?
HS: The digital and biological revolutions will continue to bear fruit—innovations in how we access and process information; how we see; how we design and fabricate cell, tissue, and organ replacements; and how we come to know through diagnostics. These will all become “real” in the near future. What is less clear is if and how the profession will embrace change, innovation, and new discoveries. Are we prepared for the coming events?
ID: If anyone can become excited about research, it is you. Can you comment on the state of dental research in the United States in terms of money, priorities, and interests? And what does this portend for the profession?
HS: The major source of funding for biomedical research in the world is the NIH. Today, the NIH budget is over $30 billion per year and there are more than 20 different Institutes and Centers. The current NIDCR budget is around $400 million per year—a tiny percentage of the total NIH budget. The challenge is three-fold: 1) the NIDCR needs to leverage funds with other Institutes around areas of common interest; 2) dental schools need to produce researchers who can successfully compete for funding (the need is 80 to 100 new scientists per year); and 3) the dental profession needs to believe that science informs clinical practice and that innovations are valuable.
Dr. Larry Meskin, the former editor of the Journal of the American Dental Association, wrote a number of essays with a common theme: “use it or lose it.” I believe we should consider Larry’s words once again.
ID: There is a lot of good research suggesting different treatment considerations or patterns. Why does it take so long for this science to be incorporated into everyday clinical practice?
HS: This is an excellent question, raising the issue of why and how we change our behaviors as professional dentists. What did it take to adopt infection-control measures in US dental offices? Computers for the dental office? CAD/CAM technology? Improvements in therapeutics?
Some of us seek “thought leaders” to tell us what is best. Others change through reading specific periodicals or information on the Internet, yet others gain new approaches and change as a result of CE courses. However, some believe that change is an “enemy,” and they continue to practice as they were taught in dental school many, many years ago.
I have read that dental professionals in America were early adopters of x-rays at the beginning of the 20th century, approximately 15 years after Roentgen made his original observations. Today it might take a much longer time. Some feel it is because of the costs related to clinical research and clinical trials. Others believe we have too much regulation around patient safety.
ID: Can you expand a little on why it takes so long to translate research into practice? Is it because people have this aversion to risk and that means an aversion to change?
HS: Very likely. Recently I had reason to read a Rand Corporation (the Santa Monica think tank) report. They were asked to analyze the quality and behavior of practicing family medicine and primary care physicians around a number of relatively common conditions, and the one I found most interesting was peptic ulcers. In 1980, a couple of Australian scientists made the discovery that H pylori bacteria was found in people with peptic ulcers. They published in the New England Journal of Medicine (eventually they received the Nobel prize). And an enormous number of people learned about the two approaches to patients who present with peptic ulcers: antibiotics, or talk therapy to manage stress. Now it is 30 years later, and only 50% of primary care physicians write antibiotics for peptic ulcers. That is a shocking piece of data, because you could literally flip a coin. We do not really understand how to change professional behaviors around advances in science—it is still a mystery.
For example, Gordon Christensen has an enormous following. He is out there connecting with practicing dentists in the language that they understand and with directions that are relatively easy to follow. He has been a very proactive thought leader. I might not agree with every position that he takes, but he is out there on the circuit, connecting with maybe 50,000 to 60,000 dentists a year, along with his various writings, CE courses, etc. We do not have very many people like that, and almost no one is advocating some of the less obvious advances in the biomedical sciences.
ID: Even after they have listened to a thought leader, a lot of dentists seem to wait for somebody in their own local community whom they respect to adopt some of these practices or procedures on more of a local level. It seems as though it takes a long time for the critical mass to come together?
HS: Yes, but that is one of the relatively new areas—the idea of the practitioners doing research. Larry Tabak and the Institute are supporting half a dozen around the country. Those are going to take a long time to gel, but that idea of practitioner-driven research looking at questions that are very practical I find to be a very attractive idea. They have been around for 25 years in pediatric medicine and have been enormously successful, but it takes about a decade to really get them to gel.
ID: Certainly that could be a good way for the average practitioner to feel closer to research? If you are part of investigating something, you are probably more likely to accept the results and do something with them?
ID: What is it like to be a dental educator today and how has that role changed—or the role of the school itself?
HS: I love being around young, bright, motivated learners—for me this has been literally “thrilling.” I have always related to terms like nurture, facilitate, mediate, and mentor. What has changed are some of the basic ground rules around intellectual property, the value of original thinking, the ethics around copying someone else’s work vis-à-vis the Internet, the social interactions within culturally diverse groups versus individual learning, and the operational costs of providing a world class dental education in the 21st century.
ID: Do you find yourself to be a different kind of dental educator these days? Do you teach differently?
HS: An example would be this week. All day Monday and Friday, I am involved in teaching dental students, but the teaching is in the role of a facilitator. I meet with a group of eight dental students for 2 hours Monday morning, then another group of eight for 2 hours on Monday afternoon. Then again on Friday, it is the same routine. I am with those students for probably six sessions, so I get to know their names, where they went to school, the way they think, and socially if I want to. It is a very exhilarating experience. Years ago I did this standup lecture approach—the classes were between 120 to 140 dental students. Rarely would I lecture for a whole course, I would be a guest lecturer for three or four sessions, and it was a very different experience, much more superficial. I had no idea whether the students cared or not. What we are doing now with problem-based learning is infinitely more gratifying from the point of view of the faculty member, and I think the students love it because they really get to know the faculty.
ID: Does being a good teacher require a whole new set of skills today?
HS: In some ways it is like parenting. When I think of the so-called parenting techniques that my generation used, then I flash forward and look at how my children are parenting their children—there has been some progress, I think, in the idea that you are raising a child or that you are nurturing a student. Not just from an obedience point of view, but you are really trying to develop a peer. The peer relationship in a faculty–student setting can be enormously exciting; I am very much loving it.
ID: Do you think that is becoming more the norm across the schools?
HS: No. Although it would have a different name than “problem-based learning,” many clinical faculty work with small groups of students. It is an assemblage of a team, 8 or 16 students—whatever the school philosophy is. They may get a little bit of this, because they have got that daily interaction with students, and there is lots of learning moments on the clinic floor or in a hospital rotation, times like that. But most schools, I think, have shied away from problem-based learning because it is labor intensive, so the perception is therefore it costs more money.
ID: Does it?
HS: I think it does, but if you are a medical or dental school where you have full-time faculty, and you have residency, post-doctorate, and graduate programs, the workforce is very easy to put together. But if you do not have that kind of structure, then it would be very expensive.
ID: Tell us more about the work that you find exciting these days.
HS: The “tools” today for doing science are fantastic—stem cells, transgenic strains of animals, the databases of human and microbial genomes, laser techniques to isolate individual cells, the design and fabrication methods for tissue regeneration, real-time micro-MRI imaging, and so much more. The “in progress” studies for head-and-neck cancers, neurological tissue regeneration, prevention of various diseases and disorders, saliva as a diagnostic fluid—are all wonderful!
ID: In closing, any last thoughts that you believe our readers would be interested in?
HS: Through my prism, I am hoping to see a time when multidisciplinary teams of people provide advances in research and other teams provide coordinated and comprehensive healthcare that includes mental, vision, and oral healthcare. If this is to ever happen, it needs to start at the university level and move to the larger society.
ID: Anything else that you would like to share?
HS: I am serving on one of the IOM panels looking at oral health and addressing a question that Kathleen Sebelius challenged the IOM to look into—which is, rhetorically, “can the mouth be put back into the rest of the body?” There are two panels, one is dealing exclusively with access. I am on the other one, which is looking at the larger picture of coding, computer technology, integration in the health sciences, core competencies, and those types of issues. We have met four times; our recommendations are not over yet. The recommendations should be approved and completed around March or April of next year. I am finding this a very challenging and positive experience, it is a nice mix of people from around the country, dealing with a lot of issues that I have thought about and often struggled with in my professional life. I am very much enjoying this process.
ID: When you are finished with that, maybe we will come back and do another interview about it?
HS: Of course!
About the Interviewee
Dr. Slavkin was the dean of the University of Southern California School of Dentistry from August 2000 until his retirement in December 2008, and continues to be a member of the faculty. He joined USC after serving as the sixth director of the National Institute of Dental and Craniofacial Research, one of the National Institutes of Health. Dr. Slavkin is a member of the Institute of Medicine of the National Academy of Sciences; a Fellow of the American Association for the Advancement of Science, the American College of Dentistry, and the International College of Dentistry. He is also a past president of the American Dental Research Association and a member of the International Association for Dental Research.