A Conversation with Charles N. Bertolami, DDS, DMedSc
The dean of New York University College of Dentistry seeks to strike a balance between emotional intelligence, scientific judgment, and technical excellence in dental education
INSIDE DENTISTRY (ID): What was it about a career in dentistry that attracted you to the profession and your specialty?
Charles N. Bertolami (CNB): I probably became interested in the field much earlier than most people—at about age 11—mainly because I was attracted to technical things and using my hands. Dentistry blended the technical, artistic, and scientific, while offering the opportunity to do something valuable that people appreciate.
When I was in dental school at Ohio State University, I was initially drawn to oral and maxillofacial surgery, but developed an additional interest in research during a National Institute of Dental Research summer research program at the University of Colorado in Boulder. Seeking a dual program, I ultimately attended the Massachusetts General Hospital-Harvard oral surgery program because it enabled me to combine research and surgery.
ID: You now serve as the dean of New York University College of Dentistry, the nation’s largest dental school. What led you to a pathway in academic leadership?
CNB: I would say I became a dean, not out of any desire for leadership, per se, but because it encompasses research, teaching, and clinical care, but at a different level of implementation. The real work is done by faculty and students, but deans can influence these critical activities by managing resources—human, physical, and financial. The intent is to blend assets to foster opportunities and to increase available options for everyone in the organization. Leadership positions in a capitalistic society, where the prevailing structure is corporate and the focus is on the bottom line, usually include titles like CEO, CFO, or COO. But what lubricates the system and makes it work in its entirety are the exceptions, the little protected niches where pure capitalism is suspended in the interest of making society function as a whole. Examples include pre–managed care medicine, where physicians and the patients they cared for had a deep bond with less concern about cost—at least that’s how it felt. Other examples might include educational organizations, religious institutes, and mutual aid societies. All were given a lot of latitude in their operations and were largely excluded from the profit motive driving the rest of society. I don’t think it’s any coincidence that universities were outgrowths of the church. In fact, the term dean is a religious title. It’s not about being in charge; rather, the word that best suits the role of dean is pastor, in the sense of shepherding, guiding, and assisting.
ID: How has the role of dean changed since you first assumed that title at UCSF in 1995, and how do you prioritize your time to meet the demands?
CNB: Going back to the founding of many of the dental schools in the 1800s and until relatively recently, there was no such thing as a professional corps of full-time deans. Then, the dean of the dental school was a highly regarded dentist in the community who assumed the role on a part-time basis, not as a job, but as a long-standing voluntary association.
Over a relatively short period of time, this somewhat honorary role has become a demanding job that is more than full time; it’s constant. In 1995, hardly anyone was using e-mail. Now, with smartphones, tablets, and otherwise being continually connected, everyone’s expectations have changed, blurring the separation between professional and personal life.
However, knowing I can’t do it all, I have learned to differentiate between the obligations only the dean has the authority to handle—especially long-term, school-wide decisions and relations with the university or the public—and those that can be handled by others. It all comes down to a division of labor, which is the wonderful thing about being at a large dental school; you can have a greater division of labor and the resources to bring in more people with special expertise and talent.
ID: Teaching an understanding of the sciences and competency in the clinical skills are essential elements of developing students into dentists. How does NYU help students develop all the other essential attributes of being a dentist?
CNB: At NYU, the faculty has defined three overlapping attributes—like a Venn diagram—that dental students should strive to possess and that permeates our entire curriculum. They include: technical excellence; an identity as men and women of science; and an indefinable something more, akin to emotional intelligence, that people expect from a doctor.
To elaborate, students should aspire to achieve technical excellence, with mere competence as a fallback position. The idea of cultivating an identity in students as men and women of science may sound like a platitude, but we use a meaning borrowed from Tony Iacopino, DMD, dean at The University of Manitoba: “a sophisticated consumer of research,” someone who knows that a scientific literature exists; knows where to find it; can read it and find it intelligible, can critique it; has the capacity to distinguish what is true from what is not true; and who can identify treatments that are safe and effective. This is more important than ever in this era of junk science. The third element is based on the work of Daniel Goleman, whose book Emotional Intelligence highlighted the importance of interpersonal skills. It includes qualities people expect in their doctors, such as being ethical, sympathetic, and caring in their relationships, as well as being comfortable with themselves and others in their environment.
ID: One of your main scholarly interests is professional ethics. How did this interest develop, and how can ethics be imparted to students?
CNB: My focus on this issue does not come from the position of a professional ethicist but from that of a pragmatist concerned about the problem of ethical misconduct among students. As a dean, I’ve had to deal with inconsolable parents and immensely distraught students as a result of ethics-related disciplinary actions, including dismissals.
The fact of the matter is that ethics is not an abstraction. It is one of the essential elements we try to instill. Students need to understand the value of the good they can do as dentists and realize it’s not worth risking that by taking foolhardy chances.
We’ve found that one way of dealing with student misconduct has been to treat students like the adults they are and not to pit students against faculty. One way we try to do this is by a peer-review committee composed of two students from each class, with the chair of the student council as chief judge and a faculty advisor. Some cases are dismissed or result in relatively minor disciplinary actions, but some students have been dismissed from school. This has been an important experience for members of the peer-review committee—many of whom have had sleepless nights when deliberating a case.
A program that has encouraged ethical behavior in a positive way is the clinical outreach program run by Stuart Hirsch, DDS, vice dean for International Initiatives and Development. These 200 students return from this experience abroad transformed. I think it’s because they experience the travel, the risks, the inconvenience, and the exhaustion, but know that they are doing so willingly, purely from intrinsic motivation, not the prospect of an external reward like credit, grades, or money. For students, this goes directly to the human dimension of doing something good with their lives and it has a big impact on them.
ID: How would you describe the key changes that have taken place in dental education—including faculty shortages—and their impact on the profession?
CNB: I had the opportunity to look into this in some detail as the primary author of the oral health chapter of the 2011 report of the National Research Council on research training in the biomedical, behavioral, and clinical research sciences. The key evidence for a shortage of dental faculty is found in the annual number of vacant budgeted faculty positions—amounting to just over 300 such positions in 2007–2008. By way of comparison, the analogous figure was just under 300 in 1969. While much has been made of the number of vacant budgeted faculty positions as a metric for a faculty shortage, a difference of just about 20 when comparing 1969 to 2008 does not seem that impressive over a nearly 40-year time span. What is impressive, though, is that in 1969, of the nearly 300 full-time vacant budgeted positions, more than 100 were in the basic sciences. Between 1998 and 2008, the number of biomedical science faculty declined nearly 30%. Interestingly, there were almost 2,000 faculty members in basic science departments in dental schools in 1982. If used as a basis of comparison, it would account for a dramatic 65% drop in biomedical science or basic science faculty in a little more than 25 years. It does appear that dental education is moving away from the biomedical sciences in its educational programs.
I think this trend is going to continue: Using the Carnegie Classification of Institutions of Higher Education, dental schools are no longer being established within the highest Carnegie classification of “doctorate-granting universities with very high research activity” (RU/VH) or “high research activity” (RU/H). Today, new dental schools are mainly associated with parent universities identified as “special focus institutions.” This is not necessarily a bad thing, but I do think that the existence of dental schools at the most prestigious universities in the country has made a difference in the perception and the advance of the dental profession as a whole. I do worry that the richness and diversity of health sciences education within a major research university is at risk of being lost.
ID: How then can the profession develop such intellectual contributors among the ranks of dental students?
CNB: This is an interesting dilemma that is especially pronounced because of the nature of dental students and the short duration of their university-based education. While few openings for tenured-track professors in most disciplines go begging, in dentistry, it is a struggle to find someone both interested and qualified for these slots. This is partly because dental students generally start out wanting to be dentists, not professors, and those who might like to lure them into academia must convince them within just 4 years to change their career goal from being a dentist to being a professor. At least in medicine, there are many more years of exposure to institutional practice and role models who embody what a university is all about.
My suggestions for attracting and retaining excellent students and practicing dentists to academia include a combination of incentives and role models. I believe universities with a prohibition against full-time faculty having outside practices restrict their ability to attract excellent people. Schools that allow a full-time dental professor to maintain a private practice may have a recruiting advantage in this regard. These professors would serve as role models for students.
ID: The place of research and research experiences for pre-doctoral students is frequently a contentious topic, especially among academicians. What are the main issues here and where do you stand?
CNB: I think the real issue isn’t research; it’s scholarship. Research is just one manifestation; it is one way by which a student can learn the rigor of what it means to have an hypothesis that can be tested and either rejected or accepted, and to be able to draw rational conclusions. These are not things that age or experience necessarily enhance unless an individual is open to a scientific approach and is comfortable looking at data and employing statistical methodologies. Students who engage in research get a strong background in the professional assessment of the literature and can develop, with guidance, a solid background in evidence-based practice. The argument against requiring a dental school research experience is also compelling. It focuses on the esthetic—the dentist’s deep appreciation for and satisfaction with achieving beautifully executed dentistry. So, given the limited amount of curricular time, there are those who question the extent to which we should be sacrificing this imprinting of the student with the elegance of truly outstanding dentistry for the sake of these more abstract principles of science.
I actually think they are both important and blending them is the key. There’s no need for there to be a conflict between the technical demands of genuinely outstanding dentistry and science.
ID: What do you see as the biggest challenge to dentistry today and how should the profession be adapting and working to meet this challenge?
CNB: In addition to my concerns about dental scholarship and the reputation of the profession, I see vulnerabilities related to financing dental education. Right now, it’s not at all clear that dentists whose education was subsidized by the state through in-state tuition rates are more likely to charge patients less, to accept patients on public assistance, or to settle in dentally underserved areas. Given continuing budget cuts, it’s surprising that the states that fund dental education have not yet attempted to exploit their leverage with students, who are now free to leave the state that helped fund their training after it has been received. I see this as a vulnerability and also as a great opportunity, because cash-strapped public schools should be able to provide students with the option to either pay full freight or “give back” by committing themselves to a period of public service to the funding source. It seems to be just a matter of time before states seeking to cut budgets arrive at such a solution.
About Dr. Bertolami
Charles N. Bertolami, DDS, DMedSc, is currently Herman Robert Fox Dean of the New York University College of Dentistry. He was previously dean of the University of California, San Francisco School of Dentistry. He is a past president of both the ADEA and the AADR and has served on the faculties at the University of Connecticut, Harvard University, and the University of California, Los Angeles. Dr. Bertolami’s research has focused on wound healing and connective tissue repair; however, more recently his contributions have dealt with curricular reform, the significance of research in dental education and practice, and ethics.