Contemporary Issues Curriculum Implications

Rutgers, The State University of New Jersey

Cecile A. Feldman, DMD, MBA Dean and Professor

Rutgers School of Dental Medicine

March 9, 2015

Rutgers, The State University of New Jersey

• Colonial College – founded 1766

• Land grant university

• American Association of Universities

• Big 10

• CIC

3

Newark

Arts & Sciences

School of Criminal Justice

Rutgers School of Law - Newark Rutgers Business School

Graduate School – Newark School of Public Affairs &

Administration

New Brunswick

School of Arts and Sciences School of Environmental and Biological Sciences

Edward J. Bloustein School of Planning and Public Policy Mason Gross School of the Arts Rutgers Business School – Newark and New Brunswick School of Communication and Information

School of Engineering School of Management and Labor Relations

School of Social Work Graduate School – New Brunswick

Graduate School of Applied and Professional Psychology

Graduate School of Education

Camden

Arts and Sciences School of Business

School of Law School of Nursing

Biomedical & Health Sciences

Graduate School of Biomedical Sciences

Rutgers School of Dental Medicine

New Jersey Medical School Robert Wood Johnson Medical School

School of Public Health

School of Nursing

School of Health Related Professions

Ernst Mario School of Pharmacy

Rutgers Football History

• 1 ^st collegiate game ever played

– November 6, 1869 at “Queens College” (original name of Rutgers) – Rutgers vs. Princeton (College of New Jersey)

– Score: 6-4

• 1869 Season

– 2 of three games played

– 3 ^rd game not played over concern of students focusing on the games

rather than academics

current DMD/DDS curriculum?

(n=38)

25 28

36 24

36 29

33 32 24

13 10 12

7 4 4 13

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

New types of dental providers Other health professionals providing…

Alernative models of dental delivery Safety net / Access to care Oral health care economics Advocacy Quality assurance Elecronic medical records Dentistry in the news

Yes No No Response

Is/Are the Course(s) in the DMD/DDS Curriculum Elective or Mandatory

(n=38)

23 22

35 22

24 22

29 31 18

3 1

6

1 4

1

1 1

1

2 1 2

15 12

2 15

12 10

6 6 14

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

New types of dental providers Other health professionals providing…

Alernative models of dental delivery Safety net / Access to care Oral health care economics Advocacy Quality assurance Elecronic medical records Dentistry in the news

Mandatory Elective Do Not Know N/ANo Response

Teaching Methodology

(number of responses)

23 23

32 19

32 21

24 27 16

0 5 10 15 20 25 30 35 40 45 50

New types of dental providers Non DMDs providing dental serivces Alernative models of dental delivery Safety net / Access to care Oral health care economics Advocacy Quality assurance Elecronic medical records Dentistry in the news

Other Role Play Small Group Lecture

Rapidly Changing World

• Multitude of Issues

• The media

• Advocacy

1766 1960’s Today

Landmark Reports

ADA Health Policy Institute

Media

• Newspapers

• Magazines

• TV

• Radio

• On-line news

• Social Media

Just this past week …

Consistent Themes but Varying Content

• Landmark reports

• Increasing influence of non-profit foundations

• Role of the media

• Sources of information

• Patient questions

• Legislative advocacy

• Frequent topics

– Access to care – Mid level providers

– RN’s, PA’s, MD’s providing oral health care services – Infection control

– Radiation exposure

– Harmful dental materials

– New dental therapies

Lots of Focus on Access to Care

• Critical issue

• Lots of stakeholders

• Strikes a sensitive spot

– Who are we?

• Health professional or business person

– What are our values?

– What will the future oral health workforce look like?

1900s 1910s 1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s 2010s

History of Dental Hygiene

• 1913 Dr. Fones establishes first dental hygiene education program in Bridgeport, CT. First class graduate in 1914 and work in public schools

• 1915 Connecticut Dental Practice Act defined the practice of dental hygiene

• 1916 Columbia is the first school to have definite educational requirements

• 1917 First licensed dental hygienist

• 1919 Minnesota institutes a two-year dental hygiene program

• 1910 Ohio College of Dentistry offers first formal program in “Dental

Nurses.” Ohio dentists strongly oppose dental nurses. None are ever able to enter practice

• 1920 six states have licensed dental hygienists

• 1924 Hawaii is one of the first states with licensed dental hygienists

• 1926 Thirty states have licensed dental hygienists

• 1932 University of Michigan offers

baccalaureate degree in dental hygiene

• 1945 New Jersey Dental Hygienists’ Association formed, however it is not legal to practice dental hygiene in NJ

• 1947 Minimum standards for dental hygiene

programs are adopted

• 1952 All states license dental hygienists

• 1952 Accreditation of dental hygiene programs begin

• 1960 Columbia University is first to offer a Master’s degree in dental hygiene

• 1968 First regional board examination given

• 1971 Washington State is the first to expand practice acts to include

administration of local anesthesia under direct supervision

• 1974 First dental hygienist to serve on a dental board

• 1984 Washington is the first state with unsupervised practice allowed in hospitals, nursing homes and other specified settings

• 1987 Colorado passes the first law in the country that allows

unsupervised practice for all dental hygienists in all settings

• 1990 14 states allow dental hygienists to administer local anesthetic to patients

have a self regulatory dental hygiene committee

• 1998 California passes legislation to create the Registered Dental Hygienist in Alternative Practice (RDHAP)

• 1999 New Mexico is the first state to pass a law that allows dental

hygienists to practice according to collaborative agreement with a dentist

• 2000 Over half the states allow dental hygienists to administer local anesthesia

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

History of Dental Therapy

• Dental Health Aid Therapists (DHAT’s) administer dental care to Alaska natives on tribal land

• Alaska Native Tribal Health Consortium (ANTHC) in

collaboration with tribal health organizations begins Alaska Dental Health Aide Initiative

• First cohort of students go to New Zealand for training

for dental practitioner who provides dental therapy

• Community Catalyst convenes group to develop dental therapy standards

• ADA and Alaska Dental Society file suit in Alaska Superior Court (ADA was opposed to therapists performing irreversible or

“surgical” procedures

• WK Kellogg Foundation collaborates to support an independent evaluation of the Dental Health Aide Therapist program

• Minnesota passes legislation

recognizing Dental Therapist and Advanced Dental Therapist

• Alaska Dental Health Aide Therapist Evaluation completed and published

• First Advanced Dental Therapists graduate in Minnesota

• AAPHD publishes standards for dental therapy education programs

• Kansas introduces legislation to license registered dental practitioners

• Vermont introduces legislation for licensed dental practitioner

• CODA drafts Dental Therapy accreditation standards and seeks public comments

• Public comments

• Court ruled in favor of ANTHC

• ADA and ANTCH reach settlement – ADA pledged other forms of support to meet the dental needs of rural Alaska

• CODA approves accreditation standards

Year Act Logo Legislation 1965 Social Security Act

2009 American Reinvestment and Recovery Act

2010 Affordable Care Act

2015

(Approved by NJ Senate and NJ Assembly)

NJ Oral Health Policy Center

Legislation & Advocacy

Course Description

Significant challenges face the oral health care system.

Professional dental associations are debating many of these issues and many articles are appearing in the lay literature (i.e. newspapers, radio spots, TV spots, etc.) for which dentist must be able to evaluate and respond.

These issues include health care reform, access to coral health are, oral health manpower, mid-level providers, oral health care financing and appropriate use of dental technology.

This course will examine current issues facing the oral health care system and

prepare participants to evaluate the issues and respond to them.

Learning Objectives

• Understand the oral health care delivery system and how the oral health contributes to overall health

• Be knowledgeable about the issues currently being debated by policy makers, foundations, organized dentistry, and the public

• Be prepared to participant in these discussions, evaluate

proposed solutions and help advocate for effective solutions

2015 Course

Session Topic Reference Material

1 Introduction &

Public Policy

 Pew Cost of Delay Report

 The State of Children’s Dental Health: Making Coverage Matter

2 Economic Trends  A Profession in Transition: Key Forces Reshaping the Dental Landscape (ADA Health Policy Resources Center, August 2013)

 An analysis of dentists’ incomes, 1996-2009 (JADA 143(5) May 2012)

3 Access to Care  A Costly Destination (Pew)

 Hidden America Video (5 Minutes)

 Access to Care PBS Video (5 Minutes)

4 ^Workforce

(CDHC)

 Help Wanted: A Policy Maker’s Guide to New Dental Providers (The Pew Center on the States May 2009)

 The Community Dental Health Coordinator (ADA series on Access to Oral Health)

5 Dental Therapy  A Review of the Global Literature on Dental Therapists (WK Kellogg Foundation)

 Recommended Standards for Dental Therapy Education

Programs in the United States (Community Catalyst)

2015 Course ^(Con’t)

Session Topic Reference Material

6 Financing Dental Care & Affordable Care Act

 The Role of Finance (ADA series on Access or Oral Health Care)

 Potential Effects of the Affordable Care Act on Dentistry (ADA August 8, 2013)

7 Access – Safety Net

 Repairing the Tattered Safety Net (ADA series on Access to Oral Health Care)

 Improving Access to Oral Health Care for Vulnerable and Underserved Populations Report Brief (IOM July 2011) or Summary (IOM July 2011 pages 1-16)

 Dental Safety net Current Capacity and Potential for Expansion (JADA Vol 137, June 2006 Pg. 807-815.)

8 Quality &

Electronic Health Records

 Activities of the Dental Quality Alliance (Ronald Hunt – 2013 DQA Conference Compendium)

 Pediatric Oral Healthcare Exploring the Feasibility for E- Measures (Dental Quality Alliance, December 2012)

9 Inter-professional Care

 Collaborative Practice in American Dentistry: Practice and Potential (Center for the Health Professions)

 Core Competencies for Inter-professional Collaborative Practice (Inter-professional Education Collaborative)

10 Power of the  Selected newspaper and web-site readings (TBD based upon

recent news)

Recent Changes

• Updated based upon current events

– Changes from year to year

• Approved next year as course for School of Public Health

– Will seek approvals from other schools

• Future

– Change into inter-professional education experience

– Consider integrating into regular practice management curriculum

– Consider changing into case scenario format

• Seminar participants present different points of

view while role playing