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The Effect of NIDCR R25 Grant Support on the Curriculum and Culture of a Research Non-intensive Dental School
1 Professor Department of General Dental Sciences and Associate Dean for Research and Graduate Studies, Correspondence: * corresponding author, Anthony.Iacopino{at}Marquette.edu Martin Taubman, Editor ABSTRACT Our objective was to evaluate changes in curriculum and culture within a research non-intensive dental school after implementation of programs supported by the NIH-NIDCR R25 Oral Health Research Curriculum Grant. We designed new curricular elements to foster an appreciation of research/discovery, an interest in academic/research careers, and application of biomedical/clinical advances to patient care. Funding was utilized to develop, implement, and assess a dedicated curricular track of continuous student research/scholarly activity throughout the four years of dental education. This track represented mandatory hours of didactic time exposing students to topics not traditionally included in dental curricula. Additionally, students were provided with customized flexible schedules to participate in elective "hands-on" mentored research/scholarly experiences at local, national, and international sites, including linkages to certificate, MS, and PhD programs. Funding was also used to support a wide array of faculty development activities that provided skill sets required to deliver integrated biomedical/clinical content, research-oriented evidence-based approaches to dental education, and translational case-based teaching methods emphasizing the application of new science/technologies to patient care. We measured changes in student, faculty, and institutional profiles/attitudes using traditional benchmarks, surveys, and focus groups. Comparisons were made between baseline data prior to R25 program initiation and data collected after years 3–4 of program implementation. Significant increases were demonstrated in: (1) student participation in research/scholarship, attendance at national meetings, research awards, publication of manuscripts, pursuit of advanced training/degrees, and expressions of interest in academic/research careers; (2) faculty participation in development activities, publication of manuscripts, and mentoring of students; and (3) increased institutional credibility within the university, supportive infrastructure for research/scholarship, and cultural expectations for academic excellence. Thus, we believe that the R25 programming changed the culture of our dental school, creating a supportive environment for research/scholarship, increasing academic productivity, and altering the attitudes of faculty/students.
Key Words: dental education • curriculum • research • scholarship • mentorship INTRODUCTION Scientific and technological advancements that generate new knowledge continue to occur at unprecedented rates. To maintain its status as a respected scientifically based health profession, dentistry must appreciate and incorporate these advances within its education and patient care systems. We believe it is the responsibility of the dental education sector to facilitate the development of institutional infrastructures that are responsive to and supportive of scientific and technological advances. At the very least, faculty and students must become "sophisticated consumers" of research and utilize scholarly approaches to evidence-based paradigms in their clinical patient management. Those outside of dental education may assume that education/training programs regularly transfer new knowledge and clinical applications of new technologies into their curricula; however, those within dental education realize that scientific advancements usually experience a slow assimilation into the dental curriculum (Tedesco, 1996). Dental education in the United States has traditionally been characterized by discipline-based lecture-style teaching, with an emphasis on technical expertise (Hendricson and Cohen, 2001) and insufficient attention paid to the development of critical-thinking/problem-solving skills and the redesign of content/teaching approaches, thus resulting in an overcrowded and stagnant curriculum (Tedesco, 1996). Furthermore, graduates do not have an appreciation for the application/importance of research and discovery to patient care activities and are not adequately prepared to embrace technology-based education/training and informational resources critical to life-long learning and professional growth (Bertolami, 2002). Many contend that current research training programs maintain an adequate number of research/scholarly enterprises and provide opportunities to faculty for developing certain skills for their participation in research initiatives. However, recent approaches have maintained narrowly focused definitions of the perceived importance of research/scholarly productivity, the purpose of research, strategies for increasing the number of future dental researchers/educators, and methods for producing graduates who incorporate evidence-based philosophies into their practices (Bertolami, 2002; Stashenko et al., 2002). Furthermore, some potentially serious problems have developed, including insufficient: (1) numbers of current and future research-qualified academic faculty; (2) integration of dental research into the larger world of science; (3) application of research to clinical practice settings; and (4) acceptance/ownership of research by the dental community (Bertolami, 2002; Haden and Valachovic, 2002; Stashenko et al., 2002). Historically, approaches to support research/scholarship have favored accomplished investigators and established infrastructures within research-intensive institutions (Bertolami, 2002; Haden and Valachovic, 2002; Stashenko et al., 2002). Dental schools designated as ‘research non-intensive’ are usually associated with smaller universities or institutional missions emphasizing teaching/service, often lack resources required for developing an infrastructure that supports elite research programs, and are unable to sustain a critical mass of experienced faculty who are actively engaged in research and scholarly pursuits. Within these cultures, faculty members have limited time to pursue scholarly activities, because a faculty-intensive teaching curriculum dominates the environment (Dederich et al., 2004). As a result, these schools have been largely ignored, creating a large cadre of disenfranchised faculty and students with no ability or desire to contribute to the overall agenda related to the infusion of science and discovery into the dental curriculum and patient care. The present paradigm of dental education severely limits the appeal of career development and training programs, due to an overcrowded curriculum, lack of integration of biomedical/clinical sciences, and a clinical component that operates in an environment completely removed from research/scholarly enterprises (Bertolami, 2002; Stashenko et al., 2002). Within this context, research and scholarly activities become an afterthought or something reserved for a cloistered group of designated academic faculty. This traditional model must experience a paradigm shift, not only to increase the number of participants in science/scholarship, but also to enhance access to, and acceptance and applicability of, science/scholarship. We believe that every dental school must play a role in establishing a culture that attaches value to research, evidence-based practices, and career development/training programs. The NIH-NIDCR R25 Oral Health Research Curriculum grant plan represents an innovative approach to enlarging the pool of US dental schools contributing to this overall agenda. Since funding criteria emphasize curricular changes that infuse science/scholarship into dental education, and increase interest in academic/research careers rather than existing research infrastructures, research non-intensive schools can receive funding to contribute to the scientific future of the dental profession. Marquette University School of Dentistry (MUSoD) is a US research non-intensive dental school that has initiated programming supported by an R25 grant. Program elements include a dedicated research/scholarly curriculum track, consisting of both a mandatory didactic component and significant elective mentored experiences that span the entire four years of dental school (Iacopino, 2004; Iacopino et al., 2004). The goals of the research/scholarly track are to foster an appreciation of research/discovery, stimulate an interest in academic/research careers, and facilitate the application of biomedical/clinical advances to clinical practice settings. The major objective of this track is to facilitate the integration of science, scholarship, and research activities within the traditional structure of the dental curriculum, while, at the same time, allowing students to pursue alternative educational experiences consisting of mentored research programs that are flexible and accessible during regular curricular hours. These experiences range in duration from one to three months, and students can select a mentor from local or national/international sites, including linkages to certificate, MS, and PhD programs. The most unique aspect of this programming is an inter-institutional DDS/PhD program with the University of Rochester. In addition to the student component, an additional program element includes formal faculty development activities that provide training and skill sets to deliver integrated content and a research-oriented evidence-based approach to dental education. The R25-funded MUSoD model represents the first comprehensive approach aimed at changing institutional culture and increasing the pipeline of future academicians/researchers through curricular elements and faculty development programs. Reports from other dental schools indicate that when segments of this educational model have been utilized as elective or alternative student experiences, they have had a positive influence on student attitudes toward careers in academic dentistry (Valachovic, 1997; Shuler, 2001). Therefore, it is critical to disseminate the outcomes of the MUSoD R25 experience. APPROACH
Curriculum Components In conjunction with the didactic portion of the dedicated research/scholarly track, we developed a framework of "hands-on" mentored student experiences at local, national, and international sites. These experiences included traditional biomedical, clinical, and translational research, as well as educational research, certificate/advanced degree programs, and topical/evidence-based reviews. Mentored research/scholarly experiences were available to all students in good academic standing, and were structured for each student to provide a "customized flexible schedule" that facilitated participation without hardship or penalty. Students are permitted to access mentored experiences for up to three months each year. Thus, students can complete up to one year of such experiences during their four-year educational program. The highlight of the curriculum track is the inter-institutional DDS-PhD program (University of Rochester Center for Oral Biology). This program allows Marquette students to begin PhD studies with research rotations for three months each summer. During these rotations, students also complete clinical activities, so that they maintain class standing and complete the DDS program within the normal four years. The entire fourth year of dental school is completed at Rochester, with concurrent PhD coursework, research, and clinical activity. Students graduate with their dental class and return to Rochester for an additional 1–2 years to complete the PhD. Financial incentives are provided throughout the program ($6,000 each summer, fourth-year tuition coverage, and a $22,000 stipend for each additional PhD year), and these students participate in monthly research seminars or journal clubs, produce abstracts and posters for the annual Marquette Student Research Day, represent Marquette at various national/international student research symposia, and present their work at the annual ADEA/AADR or IADR meeting. Students are encouraged to submit their work for publication in peer-reviewed journals.
Faculty Development Initiative
A second phase of faculty development consisted of development of instructional/teaching skills in research-oriented areas, including: (1) development of skills necessary to lead small-group, case-based seminars effectively, involving the use of an evidence-based protocol; (2) utilization of technology in teaching and the development of electronic learning environments; (3) one-on-one teaching skills to enhance clinical learning, including questioning strategies designed to prompt students to recognize and solve patient treatment issues by applying appropriate biomedical, behavioral, and clinical science concepts; and (4) development/implementation of assessment of case-based, applied research/scholarly track components. A detailed listing of the faculty development activities completed during the R25 grant program is provided in Table 1
Assessment We measured the effects of the research/scholarly curriculum on student, faculty, and institutional profiles, using traditional benchmarks including numbers of publications, presentations, and awards, as well as institutional research spending. Survey questionnaires and focus groups—in the aggregate and subdivided for students, faculty, and institutional administrators—were used to gauge student interest in pursuing academic/research careers and student/faculty perceptions of research/scholarship in the curriculum. Also evaluated were applications of research to patient care, changes in faculty teaching approaches, and status of the dental school within the parent University. Comparisons were made between baseline data prior to R25 program initiation and data collected after 3–4 years of program implementation. OUTCOMES
Anlysis of student data indicates a continual increase in the number of students involved in research and scholarship each year (15% of the student body is now active in research/scholarship, compared with 1% prior to the R25 program) (Table 2
DISCUSSION The NIH-NIDCR R25 Oral Health Research Curriculum Grant was used to develop and implement a dedicated research/scholarly track within the dental curriculum at MUSoD, a research non-intensive dental school, along with a comprehensive faculty development program to support that curriculum. The R25 research/scholarship initiative was successful in changing the culture of our institution, making research and scholarly opportunities accessible to students as part of their normal four years of dental education. The implementation of the R25-supported curriculum model created an environment where value has been attached to research and scholarly enterprises, as well as to the application of scientific advancements to clinical practice. The performance of these students was equal to that of traditionally educated students. Assessment indicated that this new curricular track had a favorable impact on both students and faculty, leading to an increased interest in participation in research and scholarly pursuits. Additionally, the program has increased faculty research/scholarly productivity and institutional credibility within the parent University and the education/research community. The NIDCR R25 grant program emphasizes research initiatives concerning curricular changes and educational ‘best practices’ that support research/scholarship and stimulate student interest in academic/research careers. At the very least, this curricular approach will enlarge the number of individuals who can articulate the value of research and scholarship to the dental profession—a current priority of the National Oral Health Advocacy Committee and National Advocacy Network of ADEA and AADR (Bresch et al., 2006). The R25-supported curricular changes at MUSoD significantly increased student interest in academic/research careers. This is particularly important in light of current faculty shortages (Chmar et al., 2006) and the most recent data regarding US dental graduates, demonstrating that only 1.9% were interested in pursuing academic/research careers (Weaver et al., 2004). The increase in institutional research/scholarly productivity at MUSoD after implementation of the R25-supported student research program mentored by faculty confirms previous observations that the research productivity of a dental school is dependent on the availability of human resources and a climate that encourages and rewards such efforts (Brodin et al., 2002). Our increased research/scholarly productivity has led to increased prestige and credibility within our parent University, the surrounding community, and among the various national/international constituencies associated with organized dentistry and dental education/research. Our outcomes provide the first formal written report regarding the effect of an R25 program on the students, faculty, and institution in a dental school setting. The R25 mechanism facilitates educational and curricular reforms that provide invaluable insights into how one can change the culture of research non-intensive schools to support research/scholarship. To support a national/international agenda related to maintaining the status of the dental profession, every dental school should play a part in establishing a culture that attaches value to research, evidence-based practice, and career development/training programs (Iacopino, 2004).
ACKNOWLEDGMENTS This project was supported by NIH NIDCR R25 grant DE015282. Received for publication December 18, 2006. Revision received March 15, 2007. Accepted for publication March 15, 2007. REFERENCES
Journal of Dental Research, Vol. 86, No. 7,
581-585 (2007) This article has been cited by other articles:
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