November 2018 Volume LIII Number 6

 
 
 
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Feature Story

November 2018 Volume LIII Number 6

INTRODUCTION
 
Pediatric dental departments across the country are facing faculty shortages. The vast majority of pe- diatric dental graduates go into private practice following residency training. In the past decade however, the University of Washington (UW) Department of Pediatric Dentistry has graduated a significant number of residents who have pursued full-time and part-time teaching positions. Currently, there are at least 12 graduates who hold full-time teaching positions and six who hold part-time positions that graduated from UW in the last ten years. Scores of others also held various academic ap- pointments during this timeframe. Dr. Travis Nelson, a graduate and current clinical associate professor at UW, states, "The true success of an academic program may be judged by its ‘byprod- uct,’ which would be the future of pediatric dentistry in our case. Since inception, UW consistently produced high quality pediatric dentists that contribute greatly to the field as academicians, community leaders, and representatives in organized dentistry." This article aims to highlight the factors that promote and successfully lead graduates to serve in academics and/or research positions after program completion.

Many programs, such as the University of Iowa and the University of North Carolina at Chapel Hill, have historically had a reputation as academic centers with some graduates who pursue teaching and research careers. Recently, the University of Washington has joined their ranks. What do these programs that produce academicians have in common? They have a common goal to foster public health educa- tion and integrate leadership, service, research, and advocacy into their clinical pediatric dental education. Dr. Wa’ Yin Chan states that she was encouraged to pursue teaching and public health endeavors because of the strong public health component which was introduced to her while a resident at UW.

There is no uniform agreement on what defines an academic career. This spectrum includes individuals with non-clinical responsibilities, those with part-time and adjunct teaching appointments, and those with full-time faculty positions—with a range from research intensive to clini- cally intensive roles.


BARRIERS AND FACILITATORS TO CHOOSING AN ACADEMIC CAREER


At a time when dental schools and non-university programs (such as hospital and community-based residencies) face challenges recruiting and retaining faculty, academicians and administrators are left won- dering how they can encourage students to pursue academic careers. Reasons for the number of open faculty positions are multifactorial, including reduced funding to support faculty salaries, reduced funding to support dental research (a pillar of academic careers and component of advancement), and the financial opportunity cost of teaching when compared to entering private practice.

Most literature outlining reasons why people pursue academic careers is greater than ten years old, does not focus on specialty training, and does not reflect the current climate of dental education. Neverthe-
less, many of the key findings likely persist and are still relevant today. According to Schenkein and Best1, factors that promote an academic dentistry include an individual’s interest to contribute to teaching and scholarship, having positive mentors and role models, the desire to con- duct research, and long-term academic aspirations. These and mentor- ship for career development "are crucial factors in developing interest in academics among graduate dentists." The primary barrier to entering academic careers is reduced income potential and student loan indebted- ness. This is becoming a rising concern given the increase in the cost of dental  education.
 
INFLUENCES OF PRE-DENTAL EDUCATION ON CAREER DECISIONS

When students begin their pre-doctoral dental education, it is unlikely that most have been informed about careers in academic dentistry. Up to this point, most are deciding whether they want to be a general dentist or whether they want to specialize and which specialty would be the most appropriate. Based on feedback from University of Washington graduates, most indicate that they were exposed to the idea of a teaching career while in dental school or earlier. This highlights the importance of  fostering dental educators as early as the first year of dental school when students are early in the career decision-mak- ing process.

One example of early mentorship comes from the University of California Los Angeles, where faculty and selected students participate in a Basic Dental Principles selective. Participants can learn about dental careers and work
with a faculty mentor to develop and deliver a lecture to pre-dental students. Lefever and Bibb indicated that mentoring future dental educators through an apprentice teaching experience, such as the Basic Dental Principles course, has great potential for encouraging more graduates to pursue careers in academic dentistry2. A survey of dental students in  2006 indicated that factors contributing to the intent to pursue some form of faculty career were gender, plans to specialize, knowledge of academic issues, having a parent in higher education, and personal teaching experience. This study highlights that dental students in general do not possess the knowledge and in- formation necessary to make an informed de- cision regarding a career in dental education3. To address this issue, the American Dental Education Association (ADEA) developed the Academic Dental Careers Fellowship Program with the goal of providing both students and residents the opportunity to gain exposure to academia through structured mentorship, training, and information about academic ca- reers. Expanded awareness through programs like UCLA’s Basic Dental Principles course and the ADEA Academic Careers program have the potential to recruit academicians early. Dr. Jessica de Bord, a graduate from UCLA and participant in Basic Dental Principles, became interested in teaching prior to attending UW. She was drawn to UW because "they educated [them] to understand the big picture beyond restoration of teeth, from the child and family level, to the community level, to the policy and advocacy level."

INFLUENCES OF RESIDENCY EDUCATION ON CAREER  DECISIONS: CREATING A CURRICULUM THAT TEACHES MORE THAN DRILLING AND FILLING

We recognize that the decision to enter academics may not be realized during dental school. Many people may not choose to pursue teaching until early—or even late—in residency education. This highlights the im- portance of  mentorship throughout residency. Dr. Glenn Canares describes that "during resi- dency, it was good to have both experienced faculty and junior faculty serve as mentors. The experienced faculty served as examples of the long-term career opportunities" while the junior faculty were "people he could relate to more easily." Graduates consistently describe the mentorship from both junior and senior faculty as key influencers in their decision to pursue  academics.

Through the application review process, faculty at the University of Washington indicate that they seek to matriculate residents that have the potential to become leaders in the field of pediatric dentistry. Dr. Joel Berg, former department chair and dean at UW stated, "We are not only training first-rate dentists and pediatric dentists, we are also teaching future teachers to teach." While academic performance and potential for clini- cal success are highly important factors, their evaluative criteria also emphasize service, life experiences, leadership, and advocacy. This suggests that UW residents may represent a self-selective group of individuals who have academic potential; however, components of the residency program also promote academic development that sets graduates up for success in academic careers.

Through the Maternal and Child Health Bureau, the University of Washington received funding to support dual degree pro- grams in Pediatric Dentistry and the School of Public Health. Under the leadership of Dr. Penelope Leggott (Professor Emeritus), two residents per year participated in a three-year program that included a Certificate in Pediat- ric Dentistry, Master of Science in Dentistry, and Master of Public Health. Both two-year and three three-year residents received didactic and practical experiences that foster public health training with an emphasis on maternal and child health education. A survey of graduates suggests that this formalized training has a high propensity to develop indi- viduals that pursue academic careers. Dr. Elise Sarvas stated: "From the day I interviewed, UW professed its mission to be a public-health program. It is unique in that it truly sees the discipline of  pediatric dentistry through that lens."

Embedded in the UW curriculum are opportunities to participate in pre-doctoral teaching. Under the guidance of  clinical faculty, residents serve as teaching assistants for dental students during student rotations  in the pediatric dentistry clinic. Furthermore, the program has strong support for resident research projects. While many students may feel overwhelmed by the idea of conducting clinical, biomedical, or behavioral research, strong research support encourages intellectual curiosity, interest, and potential for future research collaborations after residency. Dr. Karin Herzog took full advantage of research opportunities while at UW and now serves
as Director of Research Statistics at Boston Children’s Hospital. She stated that UW "em- ployed experts from other disciplines, such as biostatisticians, psychologists and epidemiolo- gists. Access to these diverse experts enabled multi-disciplinary research" and allowed her to complete "several research projects as part of [her[ residency, and through this experi- ence strengthened [her] interest in research."

Under the guidance of  program leadership such as Dr. Joel Berg (past Department Head and Dean), Dr. Rebecca Slayton (past Depart- ment Head and Program Director), Dr. Travis Nelson (Clinic Director), Dr. Marcio da Fon- seca (past Program Director), and other past and present faculty, there has been substantial mentorship to pursue academic careers that include research, involvement with advocacy and organized dentistry, research and publica- tion, and strong clinical training. There is also strong support from Dr. Elizabeth Velan (past Program Director), Dr. Joseph Kelly (past interim Program Director), and other full- and part-time faculty to pursue hospital dentistry. The reputation of  leadership in the department provides significant opportunity for strong mentorship, a key factor in develop- ing graduates who aim to pursue academic careers.

This highlights that the University of Washington has developed a culture that aligns with the traits and career interests that are founda- tional to academic careers. Furthermore, as Dr. Elizabeth Velan describes, she chose to enter a teaching career because she had "faculty that appeared to enjoy their jobs!"

COMMON MISPERCEPTIONS ABOUT ACADEMICS

Many graduates report that they may not consider academic careers following graduation because they do not feel ready without having clinical experience following graduation. The late Dr. Suzi Seale frequently addressed this concern with students and sug- gested that new graduates consider teaching immediately following residency. She indicated that pediatric dentists who become "settled" in clinical practice may find in difficult to return to teaching after establishing themselves in practice. Graduates must also recognize that to graduate from a Pediatric Dentistry program, they must achieve competency in all areas out- lined by the Commission on Dental Accredita- tion and therefore likely have the capability to become strong educators immediately follow- ing completion of residency. Although it may be beneficial for individuals to pursue full-time academic positions early in their academic career to realize their full potential, there are always opportunities to return to teaching mid- and  late-career.

For individuals who may not be interested in full-time academic careers, there are many opportunities for part-time teaching posi-  tions in community health centers, hospitals, dental schools, and other settings where dental
students and residents train. Full-time academi- cians often encompass the pillars of academic development, which include scholarship, re- search, and service. This also normally includes administrative responsibilities. In addition to these obligations, full-time clinical faculty often also provide direct patient care through intramural or extramural practice. Most part- time teaching positions are usually devoted to clinical teaching, but part-time faculty still can become involved in didactic teaching, scholar- ship, service, and other components that are foundational in full-time careers.

While income potential and high loan debt are the most commonly cited barriers to aca- demic careers, there are other benefits to offset these concerns. Many full-time positions offer the potential to supplement base salary through intramural or extramural practice, fringe ben- efits, healthcare, retirement, monetary support for professional expenses, and allowed time-off. Practitioners in private practice may report limited scheduling flexibility, uncompensated sick and vacation leave, and the feeling of geo- graphic anchoring after establishing themselves in a practice setting.

FEDERALLY FUNDED PROGRAMS TO SUPPORT FACULTY LOAN REPAYMENT AND ACADEMIC CAREERS

Through the efforts of the American Academy of Pediatric Dentistry, three cycles of  dental faculty loan repayment have been funded by the Health Resource and Service Administration (HRSA). This program has the potential to significantly reduce the financial barriers of  student loan repayment while serv- ing as faculty. As Townsend and Chi describe, numerous opportunities exist through faculty compensation models and loan repayment programs that make an academic career finan- cially viable4. Many gradutes from the UW are currently participating in these faculty loan repayment programs. Additional programs are available through the HRSA Bureau of Health Workforce to support individuals from disad- vantaged backgrounds in health professions and through the National Institute of Health to support individuals that perform biomedical or behavioral research5.

While the programs support direct loan re- payment, HRSA has also funded pre-doctoral and post-graduate training grants to improve access to underserved individuals. These grants do not fund faculty loan repayment, but do have the opportunity to expose dental students and residents to key factors facing public health, dental education, and health services research. These programs foster both direct patient services while also providing enhanced education that may support and encourage future academicians.
 
Dr. Ian Marion describes that he is able to overcome financial barriers through faculty loan repayment programs, faculty practice, and fringe benefits—"though faculty may still earn a lower salary overall, the gap is not as wide as it may seem when comparing annual salary."

CONCLUSION

The University of Washington has emerged as a program with a reputation for developing academicians. It is important to explore the factors that lead graduates to pursue academic careers, and UW, among others, may serve as
a model. This is important at a time when the number of open faculty positions in U.S. dental education continues to rise. Literature suggests that mentorship during dental education and residency may increase the likelihood of stu- dents to enter academic careers. The primary barriers are financial. AAPD’s success in advo- cating for faculty loan repayment programs, in addition to other federal programs, may offset some of the concerns surrounding student loan debt as a barrier to pursuing academic careers. Notwithstanding, the UW curriculum embrac- es and provides strong mentorship for research, service, advocacy, and leadership in addition to strong clinical education. These align with the principles of academia: scholarship, service, and research and may therefore lead graduates to consider teaching.


1Schenkein, Harvey A., and Al M. Best. "Factors considered by new faculty in their decision to choose careers in academic dentistry." Journal of Dental Education 65.9 (2001): 832-840.
2Bibb, Carol A., and Karen H. Lefever. "Mentoring future dental educators through an apprentice teaching experience." Journal of  Dental Education 66.6 (2002): 703-709. 3Rupp, Jeffery K., Daniel L. Jones, and N. Sue Seale. "Dental students’ knowledge about careers in academic dentistry." Journal of  Dental Education 70.10 (2006): 1051-1060. 4Townsend, Janice A., and Donald L. Chi. "Academic Pediatric Dentistry is a Rewarding, Financially Viable Career Path." Pediatric dentistry 39.5 (2017): 361-363.
5Faculty Loan Repayment and Grant Programs, Accessed September 2018 https://www.adea.org/professional_development/academic_dental_careers/Pages/FacultyLoanRepaymentandGrantPro- grams.aspx

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