75th Anniversary Summit Conference 1

The Center forEducational Policy and ResearchConcept PaperN. Karl Haden, Ph.D., Associate Executive Director for Educational Policy and Research,American Association of Dental Schools

Abstract: To move forward with the initiatives established by the Leadership Summit Conference, AADS will create aCenter for Educational Policy and Research. The goals of the Center are fourfold: 1) to conduct educational policy researchand studies in areas relevant to the needs of dental education over the next five to ten years; 2) to stimulate discussion andto recommend policies to AADS leadership about significant issues affecting the relationships of dental education to highereducation and to the oral health of the public; 3) to underpin the fundamental importance and responsibilities of a dentalschool within the academic community of a modern university and emphasize how its unique activities contribute to, aswell as benefit from, the parent institution; and 4) to guide the development of future leaders for dental education and highereducation. The AADS Center for Educational Policy and Research will utilize an Advisory Board of national and interna-tional leaders in dental education, higher education, and the dental profession.

Today, more than ever, higher education is sub-ject to the forces of change from the economy,demographic shifts, federal and state policies,

and public opinion. Information technology meansgreater accessibility, new ways of teaching, learning,and researching, and an explosion of new opportuni-ties. Any classroom, teacher, student, text, or data setis accessible from nearly any location in the world in amatter of seconds. Change is a constant of all viablesystems and organizations. Change, and even crisis,evokes new thinking, responsive stewardship, and col-laborative problem solving to envision and shape thefuture. Policy makers, public opinion leaders, acade-micians, and other stakeholders must recreate the aca-demic enterprise to meet emerging challenges.

Just as the academy at large is subject to change,so are its schools and colleges. This is especially truein health professions education. Dental education con-tinues to benefit from expanded oral health researchsupport, inclusion in Graduate Medical Education fund-ing for dental residents, a growing demand for oralhealth care providers, and the opportunity to open twonew dental schools. In spite of these successes, dentaleducation programs are facing increasing pressuresfrom both external and internal forces.

Between 1984 and 1994, six private dentalschools closed. In 1998, the President of NorthwesternUniversity announced the closing of its dental school.With this closing, 54 dental schools will remain in the

United States. Dental education and oral-craniofacialresearch are essential components of the university,because they add to the diversity and strength of thescholarly enterprise and ultimately contribute directlyto the quality of human life.

“Dental education has arrived at a crossroads,”concludes the most comprehensive study of dental edu-cation to date. In 1990, a group of leaders from dentaleducation asked the Institute of Medicine (IOM) toundertake an independent assessment of dental educa-tion. The result of that request included an eighteen-member committee of experts from higher education,the health professions, oral health and health servicesresearch, dental practice and education, health caredelivery, financing, and public policy. Over severalyears, the Committee on the Future of Dental Educa-tion and its staff engaged in broad-ranging efforts tocollect information on dental education in the contextof the health professions and health care delivery. In1995, IOM published the Committee’s findings andrecommendations in Dental Education at the Cross-roads: Challenges and Change.1

The Committee observed that in the past 150years dental education has evolved from an apprentice-ship to a comprehensive program of professional edu-cation. Dentists are respected professionals and dentalschools exist as a part of many of the nation’s leadingpublic and private universities and health science cen-ters. Moreover, dental education has evolved beyond

2 American Association of Dental Schools

the training of practitioners alone to the education ofscientists and researchers. Ongoing oral health researchcombined with advances in the biomedical scienceshave led to vast improvements in both oral and sys-temic health. Nevertheless, the dental profession facessubstantial challenges in such areas as work force poli-cies, licensure, and health care restructuring.

Dental education must engage not only the chal-lenges facing the profession, but also issues of accredi-tation, future faculty and researchers, cost of educa-tion, the relationship of the dental school to its parentinstitution, and others. Without a concerted effort forinnovative policy formulation and implementation,some less-than-optimistic predictions about the nextdecade in dental education may become reality:

• The current shortage of faculty, particularly full-time clinical faculty, will grow more acute.

• The need for oral health researchers will grow, whilethe number of researchers will decline.

• The cost of dental education will continue to rise,as will student debt.

• The number of underrepresented minorities in den-tal education will plateau at current levels or de-cline.

• The number of applicants to dental schools willdecrease as will the ratio of dentists to population,raising further questions about access to care, par-ticularly for the underserved, and about the intel-lectual quality of dental school applicants and thefuture profession.

The threats and weaknesses faced by dental edu-cation are more than equaled by the opportunities andstrengths:

• Funding from the National Institutes of Health fororal-craniofacial health research will remain strong.

• Relative to medicine, the dental profession will re-main somewhat insulated from managed care, thusoffering an alternative practice modality to studentscontemplating a career in the health professions.

• Information technology will revolutionize the den-tal education curricula, oral health research, anddental practice, creating opportunities for distancelearning, virtual reality simulations in teaching, test-ing, research, and licensing, and allowing greateraccess to critical data.

• Regional collaborations between dental schools willeliminate redundancy in the education and researchactivities of schools and will lead to cost savings.

• Interdisciplinary efforts between the dental schooland other colleges and schools within the univer-

sity, as well as collaboration involving oral-cranio-facial health and health services research will grow.

• Dental schools will become more closely tied tothe mission of their parent institutions through con-tinuing commitments to short and long range plan-ning.

• Research into the epidemiology of oral health andsystemic health will create new opportunities forcollaborative efforts and impact the dental schoolcurriculum and the practice of the profession.

• Loan forgiveness and improved loan repaymentoptions will continue to create opportunities for stu-dents to afford dental education. New debt man-agement programs are likely to emerge forunderrepresented minorities and those wishing topursue academic careers.

In the IOM report, the Committee on the Futureof Dental Education concluded that, “dental schoolsmust remain part of the university rather than once againbecoming independent institutions without the relation-ships to other professional, scientific, and humanitiesprograms provided by the universities.”1 To preserve andstrengthen their position within the university, dentalschools must ensure that their contributions are genu-ine and visible to their parent institutions. Motivatedby this challenge and by past and anticipated chal-lenges—including the need to boost involvement be-tween dental schools and the surrounding community,the rising cost of professional education, and the clos-ings of dental schools over the past decade—AADSposed the strategic question in its 75th year: How canthe dental school strengthen its value to the universityand the community of which it is a part? The purposeof the Leadership Summit Conference built upon Rec-ommendation 15 of the IOM study:

To consolidate and strengthen the mutual ben-efits arising from the relationship betweenuniversities and dental schools, each dentalschool should work with its parent institutionto,

• prepare an explicit analysis of its positionwithin the university and the academic healthcenter;

• evaluate its assets and deficits in key areasincluding financing, teaching, universityservice and visibility, research and scholarlyproductivity, patient and community ser-vices, and internal management of change;and

• identify specific objectives, actions, proce-

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dures, and timetables to sustain its strengthsand correct its weaknesses.1

If, according to the 1995 IOM report, dental edu-cation stood at the crossroads, has dental education to-day determined the all-important direction it will take?On October 12-13, 1998, forty-seven dental schooldeans and forty-two senior university administrators,along with a number of other leaders in health carepolicy, oral health research, and higher education, metin Washington, D.C. to forge new directions in dentaleducation. This Leadership Summit Conference, a spe-cial conference in celebration of the 75th Anniversaryof AADS, established dental education as the first inhealth professions education to create such a forum forenvisioning the future.

The Leadership Summit Conference was the firstcalculated step beyond the crossroads. Not only did theSummit Conference lead to discussions of many of theIOM recommendations, it established a new leadershiprole for dental educators in shaping educational policy.The next step to move this agenda forward and to en-sure that these critical issues receive the continuousattention of national leaders in higher education, den-tal education, government, the profession, and indus-try is the creation of a Center for Educational Policyand Research.

To build on the momentum from the LeadershipSummit Conference, AADS received a grant from TheRobert Wood Johnson Foundation to create the AADSCenter for Educational Policy and Research. The Cen-ter will be located in the offices of AADS in Washing-ton, D.C. An Advisory Board comprised of nationallyand internationally recognized leaders will guide Cen-ter activities. This Advisory Board will work under thedirection of AADS leadership and will receive staffsupport from the AADS Division of Educational Policyand Research and other AADS divisions. The Centerwill pursue funding from foundations and corporationsto support its activities.

The Goals of the Centerfor Educational Policyand Research

Policy studies and recommendations for the fu-ture of the health professions abound. In 1995, the PewHealth Professions Commission published Critical

Challenges: Revitalizing the Health Professions for theTwenty-first Century. This report contained eight spe-cific recommendations for dental medicine. The Com-mission has just released Recreating Health ProfessionsPractice for a New Century. The Center for the HealthProfessions at the University of California, San Fran-cisco, recently published the recommendations of itsTask Force on Accreditation of Health Professions Edu-cation. Other reports issued in the past year contributeto shaping higher education policy, including: the re-port from the National Commission on the Cost ofHigher Education, Straight Talk about College Costsand Prices; the American Association of State Collegesand Universities’ Facing Change, Building the Facultyof the Future; and various publications by the NationalCenter for Public Policy and Higher Education.

These studies and the directions they provideshould be informative to managed change efforts. How-ever, far too often the impact of a comprehensive studysuch as the IOM study, or a summit conference such asthe AADS Leadership Summit, is diminished by thelack of an organized effort to implement recommenda-tions. In short, critical observations and strategies diefrom inattention.

As a means of fostering the AADS mission andvalues,2 the Center for Educational Policy and Researchwill ensure that existing studies and recommendationsaffecting dental education are reviewed and addressedappropriately. Moreover, the Center will engage itsAdvisory Board and other leaders in dental education,higher education, federal and state government, andindustry to examine emerging issues and to providerecommendations to the Association. While the Centermay consider a number of matters that are related to abroad range of educational policies, dental educationis the common denominator of Center activities.

The goals of the AADS Center for EducationalPolicy and Research are:

1.To conduct educational policy research and studiesin areas relevant to the needs of dental educationover the next five to ten years;

2.To stimulate discussion and recommend policies toAADS leadership about significant issues affect-ing the relationships of dental education to highereducation and to the oral health of the public;

3.To underpin the fundamental importance and re-sponsibilities of a dental school within the academiccommunity of a modern university and emphasizehow its unique activities contribute to, as well asbenefit from, the parent institution;

4 American Association of Dental Schools

4. To guide in the development of future leaders fordental education and higher education.

These goals will have both a direct and indirectimpact in assuring the health of the public.

The Center will pursue its goals utilizing a vari-ety of strategies. Among these strategies are the fol-lowing:

1.Research. The Center will utilize ongoing surveyand data collection conducted by the AADS Divi-sion of Educational Policy and Research and otherAADS divisions. New surveys and data collectionefforts will be initiated based on the Center’s needs.The Center will encourage pilot projects and col-laborative efforts among schools and programs totest ideas. In addition, the Center will utilize datafrom other policy-making bodies, higher educationinstitutions, associations, and federal and state gov-ernment agencies as a basis for its activities.

2.Policy Analysis and Recommendations. The Cen-ter for Educational Policy and Research will review,augment and integrate existing and ongoing activi-ties of other AADS divisions that maintain and ana-lyze relevant databases. The Center Advisory Boardwill utilize legislative and regulatory reviews con-ducted by AADS divisions and their advisory com-mittees. In addition, the Center will critically re-view extant studies and recommendations as ameans to analyze policy. The Center will assist in-stitutional, program, and federal and state policymakers in developing policy options and in analyz-ing the impact of policy alternatives. To move frompolicy options to the formulation of Associationpolicy, the Center’s Advisory Board will makepolicy recommendations to AADS leadership foraction.

3.Information Dissemination. Through press re-leases, special publications, web site information,forums, seminars, and colloquia, the Center for Edu-cational Policy and Research will improve the un-derstanding of all stakeholders in dental education,including the general public, about policy issues andtheir implications for dental education.

Audience and Central ActivitiesAnalyses, recommendations, and options must be

tested and refined through debate, discussion, pilotprojects, and feedback from those who have a stake indental education. Through its activities, the Center willengage the following audiences:

• National leaders in higher education, senior uni-versity administrators, and college and univer-sity trustees. These groups bring intimate knowl-edge of the realities of higher education. Useful re-search and policy guidelines require the input ofthose within the academy. Policy should empowerthese groups as leaders of change.

• Dental school deans, program directors, facultyand students. Just as policy formulation requiresthe input of senior leaders, it also requires the in-depth experiences of those who labor within thedomain for which policies form procedures. Con-tinuous dialogue involving dental school deans, fac-ulty, and students with the university at large is cen-tral to the Center’s activities.

• The professional community of dental practitio-ners. The development of educational policy is theduty of educators, but policy in dental educationcannot be divorced from the products of the educa-tional process. Engaging the professional commu-nity in policy formulation will ensure the efficacyof policy to the end of producing competent practi-tioners.

• The media. An informed public is vital to policydevelopment and application. The press, television,and radio are important tools for reaching both thepublic and their elected representatives. Use of theInternet will continue to expand as a basic mediumfor public information.

• Government policy makers and public opinionleaders. This essential audience possesses the po-sition and power to use policy for effective change.The Center will constantly engage those who areconcerned with higher education, health professionseducation, and dental education. The Center willstrategically seek to gain the interest of others bymaking clear the importance of its activities for thepublic good.

• Minority groups and the disadvantaged. Atten-tion will be given in all Center activities to equalityof opportunity and ensuring access to dental edu-cation and health gain for minority groups as wellas the medically and socially disadvantaged.

• Other health professions schools and sponsor-ing organizations. The Center will seek collabora-tive relationships for research and policy develop-ment with those who have a similar stake in highereducation. By working closely with these organi-zations, the Center will share relevant data and pro-mote the exchange of ideas among leaders in thehealth professions and dental medicine.

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• The public. As the Center engages each of the aboveaudiences, it will seek avenues to communicate itsactivities to the general public. From one perspec-tive, all Center activities are ultimately for the pur-pose of the public good and improved quality oflife.

The Center will engage these groups through avariety of means:

• Public forums to seek opinions and feedback froma wide range of stakeholders;

• Focus groups and other targeted meetings to un-derstand issues most relevant to specific groups;

• News releases to inform health professions educa-tion, higher education, the practicing community,and the general public about issues and policies rel-evant to them;

• Monographs and other policy studies and commen-taries that raise policy issues, examine alternatives,analyze choices, and provide timely information tostakeholders in dental education;

• Information dissemination via the Internet from theAADS website;

• Special conferences and symposia on critical policyissues to involve experts from dental education,higher education, the health professions, the prac-ticing community, and government;

• Pilot projects and special collaborative studiesamong schools and programs to field test ideas, todevelop expertise and supporting materials, and toserve as models for dental education; and

• International exchange of ideas will help foster thecentral and influential role of AADS members inthe provision of educational opportunities as wellas emphasizing the important and unique interna-tional influence of American dental education andresearch.

The Agenda for the Centerfor Educational Policy andResearch

The Committee on the Future of Dental Educa-tion advised that dental education is inextricably linkedto its contributions to the improvement of oral healthservices through research, education, and patient care.Moreover, this contribution must be clear to the acad-emy and the general public.1 Involvement of policymakers, senior university leadership, the practicing

community, and the public is necessary to meet the stra-tegic issues faced by dental education. The Center’sAdvisory Board will recommend an agenda to theAADS Executive Committee. Initially, the agenda willlikely incorporate strategic issues raised in the IOMreport and other recent studies, as well as those issuesarising from the AADS Leadership Summit Confer-ence.

Some of the major foci of the Center will likelyinclude:

• Integrating the dental school with the missionof its parent institution. How can each dentalschool have a clear understanding of its university’smission and strategic plan to assess the school’s fitand contribution and to make changes as needed?How can dental education create more collabora-tive activities with other parts of the university—from health professions schools, to business andeducation schools, to undergraduate programs?

• Exploring the relationship of dental educationto other health professions education. Shoulddental education become more closely integratedwith other helath professions education? If so, whatare the most feasible models? What are the emerg-ing roles for dentists, physicians, and other healthprofessionals in areas of medicine relevant to oralhealth? How does the potential connection betweenoral and systemic health impact the relationship ofdental education to other health professions?

• Seeking ways to improve the accreditation pro-cess in dental education. How can the accredita-tion process best promote continuous improvementand innovation? What strategies should be exploredto reduce the cost of accreditation? What are themost appropriate roles for practitioners, educators,and their sponsoring organizations in the accredi-tation process? How should the current AADSpolicy, Principles of Accreditation, be implementedto reform the accreditation process?

• Developing future leaders for dental educationand simultaneously for leadership in the univer-sity community. What place should dental schooladministrators and faculty play in university-wideleadership? How are future leaders in dental edu-cation best trained? From where will the next gen-eration of dental school deans come? How can den-tal education ensure a diverse group of future lead-ers?

• Promoting interdisciplinary research. What newresearch collaborations should be explored to in-volve the dental faculty throughout the academic

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health center? How can dental educators and oralhealth researchers make the most of opportunitiesthrough the National Institutes of Health and, morespecifically, the National Institute of Dental andCraniofacial Research? What mechanisms exist orshould exist to support collaborative epidemiologicstudies of systemic and oral disease?

• Training, recruiting, and retaining the futureacademic workforce. What can dental schools doto attract more students to research and teachingcareers? How does an academic career compare tothe career of a full-time practitioner? What modelsare available from other fields that might informworkforce problems? How can dental educationensure a diverse workforce?

• Increasing the diversity of students, faculty, andadministrators in dental education and therebyenriching the educational experience in aca-demic dentistry. How can schools recruit and re-tain students from a more diverse background?What can be done to create more opportunities forminority populations in dental education and theprofession? How can schools make education morecomplete through dentistry?

• Using information technology effectively. Whatare the appropriate—and inappropriate—uses of in-formation technology in the dental school curricu-lum? What is the future role of virtual reality andcomputer simulation? How will technology affectthe development of clinical skills? What role shouldcomputer simulation play in the licensure process?

• Developing new directions in dental school cur-riculum. Should the dental curriculum be less pro-cedure-oriented? Should a fifth year be added tothe dental school curriculum? Should PGY-1 bemandatory? How do dental schools develop self-directed, life-long learners? Can the dental curricu-lum be streamlined? What is the future of problem-based learning?

• Developing new systems and processes for debtmanagement. How does the cost of dental educa-tion compare in terms of return on investment toother fields? What effect does student debt have oncareer choice? What new avenues for debt manage-ment should be explored?

• Increasing the outreach and service of the den-tal school to the local community. How can den-tal schools align themselves with their universities’missions in a way to promote the public good? Withwhat professional and civic groups should dental

education build alliances? What new models of fac-ulty practice are most appropriate for the dentalschool in the local community? Do dental schoolclinics compete with private practitioners? Shouldcompetition exist?

The Center’s issue-based approach involves fivekey steps leading to its work products (Table 1). TheCalifornia Higher Education Policy Center followed asimilar approach. Table 2 illustrates how a strategic is-sue resulted in specific policy products addressing vari-ous components of the issue.

The Center for EducationalPolicy and Research AdvisoryBoard

Working under the direction of AADS leadership,specifically the Executive Committee and the Houseof Delegates, an Advisory Board comprised of nation-ally and internationally recognized leaders will helpguide the research initiatives of the Center. The Advi-sory Board will include leaders from the following ar-eas:

• Dental education• Senior university leadership• Government• Industry• Dental practice community• Research community• Allied dental education• Other health professions

The Advisory Board will be comprised of mem-bers who are neither elected officers of AADS norAADS staff members. Term of service will be stag-gered from one to three years. In addition to the Boardmembers, the President of the AADS, the ExecutiveDirector, and the Associate Executive Director for Edu-cational Policy and Research serve as ex officio, non-voting members of the Advisory Board. The AdvisoryBoard will have two officers, a Chair and Vice Chair.The Chair and Vice Chair will each serve two-yearterms. The AADS Executive Committee will appointboard members.

The composition of the Board is a reflection ofthe wide-ranging partnership that the Center will cre-ate, as well as an indication of the diversity of knowl-edge that the Center will bring to research and educa-tional policy. The Advisory Board will meet twice each

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year in Washington, D.C. Much of the Board’s ongo-ing business will be conducted by telephone, Internet,and mail.

The Advisory Board will recommend to theAADS Executive Committee an agenda for the Center’sresearch, publications, meetings, and work products.Other activities of the Advisory Board include:

• Reviewing and commenting on commissioned pa-pers and other publications

• Participating in selected Center public events• Providing advice on funding for Center activities• Reviewing and reacting to collected data and other

studies• Chairing selected subcommittees or ad hoc task

forces• Contributing to selected publications• Promoting the mission of AADS to the Center’s tar-

get audiences

Issue Component

Table 2. Issue: The Public and Private Finance of Higher Education

Activities Policy Products

State Appropriations for California HigherEducation

Tracked 30 years of state appropriations Publication: Financing the Plan: California’sMaster Plan for Higher Education, 1960 to1996

Student Aid in California Analyzed student aid sources and revenues Publication: Trends in Student Aid: 1990 to1996, including policy recommendations

Changes in State Finance of HigherEducation

Studied higher education finance in fivestates

Background case study publications fornational roundtable

Policy Implications for Federal and StateChanges in Higher Education Finance

Jointly convened the National Roundtable onthe Public and Private Finance of HigherEducation

“Shaping the Future” (published inCrosstalk); “Rumbling” (published in PolicyPerspectives); and The Financing of HigherEducation (published by Oryx Press)

Table 1. The Center’s issue-based approach involves five key steps leading to its work products

Steps

1. Strategic Issue Formulation: Identifying the most critical challengesand trends affecting dental education; determination of stakehold-ers most affected by the challenges and trends; clarifying assump-tions behind these challenges; ascertaining the impact on mission,programs, services, structure, and financial management.

Examples of Supporting Activities

• Focus group interviews• Open forums• Trends analyses• Surveys• Interviews of informed respondents• Reviews of extant data, studies, and recommendations

• Best practice modeling• Trend analyses• Contingency studies• Regulatory and legal reviews• Pilot projects• White papers/concept papers

• Subcommittee/task force reporting• Commissioned research and writing• Regulatory and legal reviews• Forecasting• Discussion and open forums about policy recommendations

involving the AADS Executive Committee/House of Delegates

• Position papers• Monographs• Web site dissemination• Press releases• Open forums

• Impact studies• Surveys• Interviews• Open forums

5. Follow-up: Periodically reviewing policy statements; investigatingthe impact and implementation; adding to or modifying originalwork products.

2. Strategic Modeling: Developing a range of options in response tothe issue; projecting opportunities and threats relevant to each op-tion; analyzing existing strengths and weaknesses.

3. Policy Formulation: Formulating policy recommendations based onthe most feasible model or models; identifying the most appropriateaudiences; developing impact statements associated with policy rec-ommendations; seeking input and approval of recommendations byAADS Executive Committee/House of Delegates to make Associa-tion policy.

4. Disseminating Information: Determining and producing a final workproduct; distributing to appropriate audiences.

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• Advising AADS staff on other matters relevant tothe activities of the Center.

ConclusionThe AADS Center for Educational Policy and

Research will help position dental educators as inno-vators and collaborators in the academic enterprise.Through the activities of the Center for EducationalPolicy and Research, the leadership role of AADS willbe strengthened as the Association addresses dentaleducation policy. Unlike some efforts in policy study,analysis, and formulation, the AADS Center for Edu-cational Policy and Research will foster continuousimprovement and innovation to anticipate and meet thechallenges which face dental education and the profes-sion. As a body that researches critical issues, engagesstakeholders through policy studies and other modesof communication, and makes recommendations toAADS leadership, the Center will be the central meansto position AADS as the leader in dental educationpolicy.

Acknowledgments

The author is indebted to those who made com-ments and suggestions on earlier versions of this pa-per. Specifically, appreciation is expressed to Dr.

Richard W. Valachovic, Dr. Wallace V. Mann, Jr.,Dr. Diarmuid Shanley, Dr. Robert L. Williams, andmembers of the AADS Executive Committee.

References1. Institute of Medicine. Dental Education at the Crossroads:

Challenges and Change. Washington, D.C.: National Acad-emy Press, 1995.

2. The Association’s Core Values are:1. Promoting and Improving Excellence in All Aspcts of

Dental Education.2. Building Partnerships in Support of and Advocating for

the Needs of Dental Education.3. Serving the Individual Needs of Members and Institu-

tions4. Encouraging Communication and Sharing of Informa-

tion Among the Association’s Members.5. Expanding the Diversity of Dental Education.6. Recognizing the Needs of Those the Association Serves7. Promoting Oral Health

The mission of the American Association of Dental Schools isto lead individuals and institutions of the dental education com-munity to address contemporary issues influencing education,research, and the delivery of oral health care for the improve-ment of the health of the public.