USC

University of Southern California School of Dentistry: Dental Education for the 21st Century

Harold C. Slavkin, DDS

Copyright 2002 Journal of the California Dental Association.

Author
Harold C. Slavkin, DDS, is the dean and G. Donald and Marian James Montgomery Professor of Dentistry at the University of Southern California School of Dentistry.

California is the fifth-largest economy in the world, with 34 million people who speak 224 different dialects and languages.¹ By 2050, California’s population will exceed 50 million people.¹ We have some of the finest universities in the world. We are innovators; and we thrive on discovery in our laboratories, clinics, and hospitals. When we think of California, many of us think about adventure, higher education and outstanding universities, information technology, biotechnology, the entertainment industries of motion pictures and television, agriculture, import/export shipping industries, cultural diversity, sunshine, physical fitness, and fun. In great measure, the universities and colleges of the Golden State have and continue to provide the talent, knowledge, and innovative technology that continue to fuel the success of California.

The School of Dentistry at the University of Southern California graduated its first class in 1900. USC has been contributing to what is thought, what is taught, and what is practiced in the oral health professions since 1897.² In 1923, USC began its dental hygiene program under the direction of Cora L. Ueland and has sustained a baccalaureate program. During the mid-20th century, USC developed a number of superb dental specialty programs in oral-maxillofacial surgery, orthodontics, pediatric dentistry, periodontics, prosthodontics, endodontics, and general practice residency, which continue to contribute to dental education and science. In 1974, USC began its graduate program in craniofacial biology administered by the Graduate School of the university, the first in the nation; and it continues to educate and train outstanding PhD graduates who serve on the faculty of many outstanding dental schools in America and abroad. In 2002, USC began its first advanced education in general dentistry program.

As USC enters this current academic year (July 1, 2002, through June 30, 2003), we are proud of our history and tradition of clinical excellence and more than 13,000 alumni in the oral health professions. For more than a century, we have taken pride in the development of professional human beings through learning and teaching, research, professional practice, and various forms of service to the community and our profession. We are extremely proud of our clinical-excellence legacy in operative and restorative dentistry as well as orthodontics, oral surgery, periodontics, endodontics, pediatric dentistry, dental hygiene, craniofacial molecular biology, and community outreach programs. We have evolved with California. We have grown through the remarkable advances made in the oral health professions, especially the profound changes and advances made in the dental sciences that affect what we teach, how we learn, and how we critically think in the 21st century.

USC has a distinguished faculty that have earned significant state, national, and international respect for their contributions to what is thought, taught, and practiced in the oral health professions. For example, our faculty contribute to organized oral health professions with individual members serving in the Institute of Medicine (National Academy of Sciences), fellows in the American Association for the Advancement of Science, fellows in the American College and International College of Dentists, Pierre Fauchard Academy, and numerous roles in the American Dental Association, American Dental Education Association, American Association of Dental Research, various dental specialties, the California Dental Association, and numerous local dental societies. Our faculty contribute through scholarship to innovation and discovery, and they are ranked No. 6 in federal research support for biomedical research among the 55 dental schools in America. USC is ranked No. 2 in the citation index for our faculty contributions to the oral health scientific literature (oral surgery, dentistry, and oral medicine). USC faculty are internationally recognized for their significant contributions to continuing dental education in dental anesthesia, medical emergencies, esthetic dentistry and dental materials, implantology, imaging, and instrumentation in dental hygiene. Since 1900, when Dean Edgar Palmer presided over the first graduation of 12 USC dental students, faculty and graduates have contributed to what is thought, taught, and practiced in the oral health professions.¹

This paper will highlight strategies and advances that will reacquaint the reader with the University of Southern California.

The Present Opportunities

The USC School of Dentistry is a "learning organization," dedicated to our own ongoing learning, flexibility, comfort with change, and openness to new ideas. We are committed to improving the health of all people through education and training, innovation and discovery, patient and community oral health, and leadership. We seek to provide outstanding undergraduate, graduate, and postgraduate academic programs of instruction for highly qualified students leading to academic degrees in the oral health professions; extend the knowledge of oral health by encouraging and assisting faculty in the pursuit of innovations and discovery scholarship; improve the oral health of the people of Southern California; stimulate and encourage in our students those qualities of scholarship, leadership, and character that mark the true oral health professional; serve California and the nation in providing lifelong learning to oral health professionals; and, provide oral health leadership in the solution of community, regional, national, and international complex problems.

Being located in Southern California )eight counties comprising 24 million people), our university is "an engaged university" that forms collaborations and partnerships with our communities to improve the quality of life. The School of Dentistry is aligned with our parent university, and we have a long and distinguished history of community outreach programs that affect the people in our region. In Southern California, 7 million people do not have dental insurance or access to oral health care; this disturbing oral health disparity is particularly pronounced in poor and working-poor people who live in our region. One major opportunity for USC and the other four dental schools of California is to collaborate to improve the safety net for larger percentages of the population with particular attention to infants and toddlers, their caregivers, and the poor elderly of the Golden State.

Of course, the recent explosion of informatics and biotechnology heralds a true "biological revolution" within dentistry and medicine. The completion of the human genome; the completion of numerous microbial genomes; the advances in diagnostics, treatments, and therapeutics; as well as novel biomaterials are affecting what we think, what we teach, and how we practice clinical dentistry in California. The intellectual boundaries of dentistry are expanding!^3-7

At USC, we consider the full array of clinical competencies that we set in our research intensive university-based schools of dentistry -- health promotion, risk assessment, disease prevention, diagnostics, treatment planning, treatments (numerous technique-sensitive procedures) and therapeutics, health services, health outcomes, multicultural competencies, patient management and human behavior, business management practices, informatics, conflict resolution, and mediation.^7-9

The knowledge and technology expansion is nothing short of remarkable. There is more to know and more to teach than ever before within the same time frame of professional dental education.^7-9 All of us in dental science, education, and patient care have a significant opportunity to rethink our admissions policies, the four-year curriculum, how we learn and how we teach, and the clinical competencies that we establish as our functional goals.^7-9 Today, we are living in a remarkable time in oral health history. We have the opportunity to revisit previous assumptions, consider the emerging new biological and behavioral sciences, consider the individual and community quality of life issues, assess the costs and management of health care, and improve the cultural diversity of our profession while increasing access to oral health care for all people.^3-6 The social, economic, and political dimensions are truly significant!

Strategic Planning, Accreditation, and University Reviews

As you read this article, I have completed just more than two years as the 11th dean of the USC School of Dentistry. Two years before I arrived, under the direction of interim dean Jerry Vale and led by Roseanne Mulligan, USC organized to engage in a comprehensive "self-study" in preparation for the American Dental Association national accreditation. This process engaged hundreds of faculty (full-time and part-time), students (dental hygiene, predoctoral, residents, graduate students), staff, and alumni. Their intensive work over two years resulted in the "self-study" documents that were submitted to the ADA. This body of information (descriptions, analyses, evaluations, and recommendations) was invaluable to me in my learning about the community culture, core values, priority setting, and ambitions for the future. The timing was excellent. The process coincided with my return to USC from Washington, D.C., where I had worked and lived with my wife from July 1995 through July 2000 as director of the National Institute of Dental and Craniofacial Research, one of the 20 institutes that make up the National Institutes of Health in Bethesda, Md. As I began my USC tenure on Aug. 14, 2000, the two-year "self-study" developed by my USC colleagues provided an opportunity to gain an appreciation for and understanding of their assessment of strengths, weaknesses, opportunities, and threats.

Independently -- under the leadership of Provost Lloyd Armstrong, Jr. -- our parent university administration and all of the colleges had completed a rigorous "self-study" that produced the university-wide Strategic Plan (1994 and revisions in 1998). This plan serves as the blueprint for developing the entire university including the School of Dentistry. The plan sets forth four strategic initiatives to leverage USC’s distinctive characteristics. The four strategic initiatives are:

* Initiative 1: Undergraduate education -- Provide a distinctive undergraduate experience built on excellent liberal arts and professional programs, incorporating unique opportunities for career preparation through innovative collaborations between the liberal arts and our diverse array of professional schools.

* Initiative 2: Interdisciplinary research and education -- Create the organizational flexibility, and capacity for teamwork, to become a world center for innovative interdisciplinary research and education in selected areas.

* Initiative 3: Building on the resources of Southern California and Los Angeles -- Create programs of research and education that utilize and contribute to the special characteristics of Southern California and Los Angeles as a center of urban issues, multiculturalism, arts, entertainment, communications, and business.

* Initiative 4: Internationalization -- Build upon USC’s strong international base of alumni, students, established relationships, and Southern California’s position as an international center to enhance future global opportunities for education, research, and career development. Because of the characteristics of Southern California and of our students and alumni, focus efforts on the countries of the Pacific Rim and of Central and South America.

In addition, the university-wide plan outlines strategies and actions to realize these initiatives and proposed four critical pathways:

* Communications -- Understanding and helping to solve technical, social, cultural, legal, and political issues of communications in its many forms.

* Life sciences -- Coordinating and building on considerable expertise in the life sciences ranging from basic biological sciences to clinical and engineering applications.

* The arts -- Coalescing our considerable strengths in the arts to move USC to the center of the cultural stage in Los Angeles.

* The urban initiative -- Exploring how complex urban environments function and how to improve them.

Importantly, the university-wide strategic plan and the work of the USC dental community meshed and indicated a clear alignment including many positive opportunities for collaborations and leveraging of resources. Five months after I began my tenure as dean, we completed and published a strategic plan for the USC School of Dentistry "Shaping the Future" (2001-2006). The plan contains our vision; mission; our "SWOT" analysis (strengths, weaknesses, opportunities, and threats); four strategic directions or initiatives; and four critical operational factors with goals and objectives. "Shaping the Future" serves as a blueprint for the future of the School of Dentistry.

USC School of Dentistry Strategic Plan

The strategic plan is organized into four strategic directions. Each strategic direction is described briefly in the body of the strategic plan followed by goals and objectives. Each of these four strategic directions detail actions to be completed within the next three to five years. The four strategic directions are:

* Education and learning -- Based on critical analyses of a five-year educational demonstration project, problem-based learning, we proposed to utilize PBL to achieve our educational goals. The PBL pedagogy emphasizes student-centered, patient-focused, small group-oriented, inquiry-based strategies of learning, with learners addressing developmentally appropriate patient-based problems.⁹

* Innovation and discovery -- The School of Dentistry plans to expand scientific research in oral infection and immunity, innovations in antimicrobial therapeutics, molecular epidemiology of complex human diseases, oral health disparities, health services and outcomes research, chronic facial pain, oral-dental-facial rehabilitation and esthetics, bioengineering, tissue engineering and biomaterials, implantology, and "virtual craniofacial-oral-dental patient reality."

* Patient care and community oral health -- Oral diseases and disorders represent the most common chronic diseases of children. In Southern California, infants, preschool, and K-12 children constitute a "silent and neglected epidemic" of tooth decay, tooth pain, oral infections, and related poor school attendance. The problems are very significant in that many of these infants and children reside in close proximity to both University Park and the Health Science campuses of USC. In addition, oral health addresses pregnancy, premature babies, craniofacial birth defects, craniofacial-oral-dental trauma, severe malocclusion, head and neck cancers (e.g. oral and pharyngeal cancers), a variety of oral and periodontal infections, chronic facial pain, osteoporosis, osteoarthritis as related to temporomandibular joint diseases and disorders, xerostomia or "dry mouth." and a number of related oral health diseases and disorders. The challenges represent the entire life span, from conception through senescence, and include individual patients, families, communities and populations. Improving the oral health of all people of all ages and all cultures is fundamental to the mission of USC.

* Leadership for the oral health professions -- Our goal is to educate and foster leadership through critical thinking, problem-solving, cultural competencies, and a shared desire to improve the health of all people. At USC, we are dedicated to nurture learners to consider multiple career pathways including careers in science, technology, education, and organized dentistry and beyond. We recognize the importance of equipping faculty and students with leadership skills and incentives so they may effectively stand for, and communicate, the USC model.

University Academic Performance Review

The University of Southern California was founded in 1880. At that time, the founders anticipated that USC would grow and evolve with the Southern California region and that USC would serve as "an engaged university" to collaborate with public and private sectors to improve or enhance the intellectual, technological, financial, and "quality of life" for the people of California and beyond. For the first 50 years, USC was Southern California’s only major university. For more than a century, USC has contributed to what is thought, taught, and practiced in the numerous disciplines that make up the university.

Inherent in success is the zeal for self-improvement. In this context, USC embraces not only the formal accreditation processes of each of its colleges, but also seeks to define each of its colleges’ academic performance by national and international objective criteria. In the late 1990s, the provost of USC initiated a series of "self-study" assessments of the academic performance of each of its colleges. The USC School of Dentistry was selected to be reviewed beginning October 2001. The yearlong process included:

* Self-assessment;

* A projected five-year written plan;

* Internal reviews by a panel of distinguished academicians drawn from throughout the university; and

* An external review and site visit by a panel of distinguished dental academicians drawn from around the country (Drs. Bruce Baume, laboratory chief, gene therapy/therapeutics, NIH; Bruce Donoff, dean, Harvard School of Dental Medicine; and Charles Bertolami, dean, UCSF School of Dentistry. Under the leadership of Chuck Shuler, associate dean for Academic Affairs, the combined final report was submitted to the provost who in turn will soon engage the faculty and administration of the School of Dentistry. Our shared goal is to define measurable goals and objectives for the School of Dentistry to attain and/or sustain pre-eminence in the oral health professions.

Prospectus

USC will complete our transition to school-wide PBL in two years. Our faculty will continue to contribute to what is thought, taught, and practiced in the oral health professions. For example, the article in this issue contributed by Drs. Paul Denny and Mahvash Navazesh indicates the numerous opportunities to improve clinical diagnosis using saliva fluid as an informative solution that reflects health and/or disease. USC faculty are significant contributors to craniofacial molecular biology, biomimetics and tissue engineering, oral cancer, biomineralization with emphasis upon enamel bioceramics, oral infection and mucosal immunity, oral microbiological diagnostics, antimicrobial therapeutics, "virtual head and neck patient" research and applications, and educational research. USC is also a major contributor to esthetic dentistry as well as implantology, and we remain dedicated to reducing oral health disparities from Bakersfield to the Mexican border using numerous venues such as community-based clinics, school sites, hospitals, and mobile units. Our new emphasis is to provide students, faculty, and staff with opportunities to address the oral health care needs of all people over the entire lifespan -- ranging from prenatal care through hospice care.³ And USC continues to be dedicated to nurturing the future leadership for the oral health professions.

References

1. Baldassare M, California in the New Millennium: The Changing Social and Political Landscape. University of California Press, Berkeley, 2000.

2. Done HN, Gardner J, eds, 100th Year Centennial of the University of Southern California School of Dentistry. USC Dental Alumni Association, Redondo Beach, Calif, 1997.

3. Slavkin HC, Expanding the boundaries: Enhancing dentistry’s contribution to overall health and well-being of children. J Dent Ed 65:1323-34, 2001.

4. Slavkin HC, The human genome, implications for oral health and diseases, and dental education. J Dent Ed 65: 463-79, 2001.

5. Tabak LA, A Revolution in biomedical assessment: The development of salivary diagnostics. J Dent Ed 65:1335-9, 2001.

6. Ratner BD Replacing and renewing: Synthetic materials, biomimetics, and tissue engineering in implant dentistry. J Dent Ed 65:1340-7, 2001.

7. Cohen MM, Major long-term factors influencing dental education in the twenty-first century. J Dent Ed 66:360-73, 2002.

8. Hendricson WD, Cohen PA, Oral health care in the 21st century: Implications for dental and medical education. Acad Med 76:1181-206, 2001.

9. Shuler CF, Application of Problem-Based Learning to Clinical Dental Education. J Cal Dent Assoc 30:435-43, 2002.