| Sign In to gain access to subscriptions and/or personal tools. |
The Endangered Clinical Teacher Scholar: Will this Eliminate Discovery from the Dental School Environment?
1 Department of Restorative Dentistry/Comprehensive Care and Correspondence: * corresponding author, moakley{at}pitt.edu Martin Taubman, Editor ABSTRACT Each year, dental schools struggle to do more with less—a reality that is confounded by dental faculty shortages and retention issues reported over the past 15 years. In today’s academic environment, faculty shortages suggest that the resulting smaller faculty population will be tasked with more responsibilities than those who had the benefit of working with a full complement of colleagues. Fewer clinical faculty will likely participate in scholarly activity—in some instances, negatively affecting their chances for promotion and tenure, and ultimately lessening their own job security and feeling of accomplishment and self-worth in the academic environment. New faculty are in need of a formal program endorsed by their administration—one which places them with colleagues experienced in scholarly activity. This program, to include a definitive reward structure for mentors, would likely foster the retention and promotion of faculty and encourage the development of future leaders of dental education. Without a definitive plan, the clinical scholar will become an endangered species, and the research innovations and discovery of our profession will fall short in addressing the needs of the public’s oral and systemic health.
Key Words: Mentoring • faculty development • translational research • dental education INTRODUCTION Each year, dental schools struggle to do more with less—a reality that is confounded by dental faculty shortages and retention issues reported over the past 15 years. The American Dental Education Association (ADEA) has been tracking these trends, and the news remains disheartening. In the year 2005, there were 417 vacant dental school faculty positions, a 26% increase from 1993. Specifically, 374 of these positions were full-time, while 43 were part-time (ADEA, 2006). Analysis of the data shows that these dental faculty vacancies are having the greatest impact on clinical sciences, where, reportedly, vacancies are at the 75% level (ADEA, 2006). Within the clinical sciences, operative or restorative sciences represent the highest number (18%) of the open positions. Of the remaining 25% of vacancies, 11% are in research, 7% in basic science, 5% in administration, and 1% each in behavioral science and allied dental health positions (ADEA, 2006). THE NATURE OF THE PROBLEM In today’s academic environment, faculty shortages suggest that the resulting smaller faculty population will be tasked with more responsibilities than those who had the benefit of working with a full complement of colleagues (Livingston et al., 2004). Roles may no longer be defined as those who conduct research, those who teach students in the clinic or classroom, or those who have an administrative focus. Faculty are recommended to balance their portfolios by servicing their dental education institution, profession, academic health institution, and university (Hand, 2006). Ideally, a well-rounded faculty member should excel in four broad areas of proficiency: the scholarship of discovery, the scholarship of application, the scholarship of integration, and the scholarship of teaching (Boyer, 1990). In today’s dental schools, it is not uncommon to find clinicians tasked with additional responsibilities beyond teaching. These include committee membership and/or chair-level involvement, administrative duties including directing courses or organization of patient clinics, and faculty and staff management. As a result, less time is available to focus on tasks that may help them develop scholarly pursuits, such as, participation in protocol-driven peer-reviewed published research, involvement in national policymaking in clinical disciplines, authorship of books and chapters, acting as an informed advocate of the scientific basis for clinical protocols, serving on editorial review boards, etc. (Shepherd et al., 2001). In short, as clinical faculty are more frequently required to service their institutions by filling the voids resulting from unfilled positions, they slip further behind in their pursuit of scholarly activity and professional development. Dental school clinical faculty who avoid pursuing research activities may contribute to a trend that should alarm the National Institutes of Health (NIH). With fewer clinical researchers, NIH’s efforts to increase translational research may be negatively affected, since taking research from bench-top to bedside will be a challenge without the research efforts of clinical faculty. The NIH has made it a high priority to increase discovery in the clinical research enterprise through the institution of the NIH Roadmap (a,bNIH Roadmap for Medical Research, 2007a,b). This initiative is targeted to provide the foundation for investigators to translate their discoveries into improved health modalities for the people of the United States. Current trends point to private practice as the source most likely to fill dental schools’ vacant positions, with 61% entering academics from private practice. Additionally, 16% come from advanced education programs, 14% from another school, 7% after graduation, and 2% from military positions (ADEA, 2006). Private-practice dentists report that the intellectual stimulation, the camaraderie, and the variety of the academic environment attract them to pursue a faculty position (Schenkein and Best, 2001). New dental educators rated a "positive departmental working environment" as one of the most important factors in their perceived importance in maintaining their academic positions. They also report that although financial sacrifices in academic careers often exist, social and intellectual interactions with colleagues are considered to be of benefit to the level that appears to offset monetary deficiencies (Shepherd et al., 2001). The literature suggests the necessity for dental educational institutions to recognize the fact that these new faculty likely lack the experience and training to perform at the level required for them to be effective and diversified academicians (Hand, 2006). They indeed may be well-versed in the trends of their specific clinical topic; however, one may ask, What in their dental education or private practice experience has prepared them to succeed as clinical scholars? As recruitment and retention trends are followed over time, it is apparent that new faculty will likely be faced with the necessity to assume more roles than their predecessors, and would demand a formal professional development program to help them stay focused on diversifying their academic experiences (Livingston et al., 2004). MENTORSHIP CHALLENGES A strong mentoring program remains one of the most time-honored professional development opportunities. There are four vital techniques of mentoring: defining goals, professional development, peer-involvement, and feedback (Taylor, 2001). Those mentored ("protégés") have reported numerous benefits from their mentored experience, to include: elevation of confidence, sparked creativity, greater understanding of administration and necessary career paths, as well as comfort in having someone who is willing and accessible to listen to their ideas (Lowe et al., 1991). These descriptions imply that the mentoring relationship is one that is to be taken seriously and requires significant time and dedication. Also, most noteworthy to a discussion regarding the prospects of dental education, these protégés are more likely to become mentors in the future (Livingston et al., 2004). With the recent decline in full-time faculty, new junior faculty with little to no direct link to academics may find it essential to connect with seasoned veterans to secure a mentoring relationship that can foster their professional development. Primarily due to their level of experience, it would appear that those in research positions are most suitable to serve as mentors to junior clinical faculty seeking to increase their scholarly activity. Unfortunately, the duties of the average researcher do not routinely lend themselves to significant interaction with clinical faculty (Krebsbach and Ignelzi, 1999). Almost 20 years ago, Tedesco challenged the leaders of the 1990s to resolve the emerging competition or tension between basic science and clinical science research (Tedesco, 1988). A more significant challenge may be to somehow allow researchers who are focused on myriad complex issues the time to add an additional item to their already-full plate. On a daily basis, researchers focus on funding levels, acquiring necessary lab space and staffing, obtaining Institutional Review Board (IRB) approval, maintaining a flow of study participants, or meeting grant deadlines and managing political interference in scientific judgments (Nurse, 2006). Bridging the gap from the laboratory to the clinic, where researchers and junior clinical faculty can collaborate, is no small challenge, given these concerns. In some schools, the direct benefit for mentoring a junior clinical faculty member is not well-defined. As junior faculty seek to develop their skills in academia and experience frustration in connecting with mentors and/or acquiring the skills to progress on their own, the likelihood that they will turn away from scholarly activity increases (Flores-Mir, 2006). Lack of collegial support, workload, and time constraints have been reported to be concerns of new faculty; moreover, feelings of loneliness and isolation have been frequently reported as two of the most significant problems faced by faculty (Shepherd et al., 2001). As they begin to focus on the needs of the institution vs. their own professional development, trends of complaints generally follow. Questions of self-doubt and a feeling of self-sacrifice tend to surface as they drive their focus toward moving the goals of their institutions forward. The clinical faculty reach a level of frustration once the perceived input related to scholarly activity exceeds the benefit or the output (Glickman et al., 2002). LACK OF SCHOLARLY ACTIVITY AND PUBLICATIONS OF CLINICAL FACULTY It has been argued that the climate of intense competition in the NIH environment may indeed serve to prevent collaboration at the level of researcher to researcher. There are fears that because less than 10% of submitted grants are awarded funding, the best and brightest will simply be turned away from biomedical research (Weinburg, 2006). The promotion and tenure guidelines of numerous dental schools clearly demand first authorship on significant peer-reviewed articles and often a consistent record of external funding to those who aspire to move forward—indirectly fostering an environment rich in competition. The desire to collaborate with colleagues is lessened as those in the tenure stream focus on their ‘primary investigator’ or ‘first author’ status. At the University of Pittsburgh School of Dental Medicine, a MEDLINE search suggests that the paucity of scholarly activity on the part of clinical faculty may negatively influence individual promotion goals. Ninety-three percent of part-time clinical faculty and 62% of full-time clinical faculty have no publications while serving in their clinical positions. Only 7% of part-time faculty and 11% of full-time faculty have published three or more manuscripts in medical/dental journals during their service as clinical faculty. While the clinical teaching needs of the institution may be adequately addressed by these professionals, the advancement of clinical research on behalf of their institution appears to have fallen victim to the clinical faculty population deficit reported across the nation. FACULTY SHORTAGE LIKELY TO WORSEN Retirement trends for senior faculty in dental education within the US are predicted to escalate in the next ten years. It is estimated that the retirement of the ‘age 60 and older’ segment alone will likely produce 900 academic vacancies by the next decade (Livingston et al., 2004). It will be unlikely that the faculty shortage issue of today will be relieved—but instead is likely to worsen. The heavy demands placed on current dental faculty across all disciplines are expected to push the limits in the dental educational environment through the next decade. As a result of this seemingly unstoppable movement leading to faculty vacancies, translational research will predictably continue to struggle to bring innovative cohorts of clinicians and researchers together. The irony is evident, since this trend moves in the opposite direction of the NIH roadmap. Fewer clinical faculty will likely participate in scholarly activity—in some instances, negatively affecting their chances for promotion and tenure, and ultimately lessening their own job security and feeling of accomplishment and self-worth in the academic environment. Additionally, the number of qualified practitioners dental schools can produce may indeed be suspect (Shepherd et al., 2001). The needs of the public may fall short, as dental institutions struggle to prepare their graduates to serve the needs of the ever-changing population. The new research which links oral health to systemic health suggests that oral health is likely to be held in a more prominent position in the eyes of the public and on the agendas of policy-makers and funding agencies (Shepherd et al., 2001). It is discouraging that clinical faculty members who lack the resources to participate in research projects will not have the opportunity to make their mark on the initiatives affecting the overall systemic health of the United States. NEED FOR FORMAL MENTORING PROGRAMS—REWARDS FOR MENTORS A modest population of fresh professionals has been willing to come forward and accept the challenges a new career in dental education will offer. The literature has supported the need for formal mentoring programs for over 20 years (Tedesco, 1988; Romberg, 1991; Metzger Samuels, 1991; Glickman et al., 2002; Hand, 2006). The call to heed this advice is upon us. New faculty are in need of a formal program endorsed by their administration—one that places them with colleagues experienced in scholarly activity. A definitive reward structure that recognizes those who serve as mentors will likely foster the retention and promotion of faculty and hearten future leaders of dental education. A PLAN IS NEEDED TO SUPPORT THE CLINICAL SCHOLAR The NIH has gone to great lengths to attempt to increase professional interactions between researchers and clinicians. One can only wonder if dental institutions can afford to continue to allow the energy and minds of their people to go underrepresented. Without a definitive plan, the clinical scholar will become an endangered species, and the research innovations and discovery of our profession will fall short in addressing the needs of our public’s oral and systemic health. ACKNOWLEDGMENTS The authors thank Drs. Thomas W. Braun, Jean O’Donnell, and Dennis Ranalli for critically reading this manuscript. Received for publication May 20, 2007. Revision received November 13, 2007. Accepted for publication November 13, 2007. REFERENCES
Journal of Dental Research, Vol. 87, No. 3,
200-202 (2008)
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
|
|
 |
|
Sign In to gain access to subscriptions and/or personal tools.
