The Brooklyn Pilot Program: Putting a New Dental Education Model to the Test

The Brooklyn Pilot Program: Putting a New Dental Education Model to the Test

09/12/2019

Nearly 100 years after the 1926 publication of the Gies Report — which established the importance of dentistry as a science, a learned profession, and an essential component of higher education in the health professions — and despite amazing advances in science and technology, the clinical-care component of dental education continues to reflect the thinking of the last century. Now, as the College prepares to open a second location in Downtown Brooklyn, we have an opportunity to improve the dental education model in a significant way. 

Dean Charles Bertolami has long believed that there is a better way to educate future dentists. In an article written in 2001, "Rationalizing the Dental Curriculum in Light of Current Disease Prevalence and Patient Demand for Treatment: Form vs. Content," he argued that "Large, inhospitable ward-like dental school predoctoral clinics are hugely inefficient and often run in a state of deficit." He continued:

They minimize the amount of dentistry students are able to do. The dedicated faculty who run such clinics have sometimes, unfairly, been called "checkers" — they check student work, teaching as best they can in the process. A possible improvement might be to partially reconfigure the way dental care is delivered in the educational setting by transferring patient care from the student to the faculty member for a defined percentage of time. This would create an additional category of mentored clinical training for students. Counterintuitively, it would actually increase the clinical experience of students and would allow clinics to run more efficiently and productively. The change in culture would be enormous because additional instructors would be needed who want to practice dentistry while teaching students. The proposed model — call it the mentor-protégé model — is not new; it is well established in hospital-based medical practice where students and professors are colleagues, all engaged in taking care of the same patients. Under the mentor-protégé model, a professor practitioner mentors a very small group of student protégés or associates. The professor is identified as the patient’s dentists, remaining so from year to year and engendering the patient’s loyalty to the faculty member-dentist and to the system. Insofar as practical, faculty and students would treat patients side-by-side. The efficiency and productivity of a private practice would not be attained nor expected, but efficiency would be much greater than it is now in most dental school clinics. 

Believing that dental schools hold the key to reforming dental education in a meaningful way, NYU Dentistry has taken the first step in bringing Dean Bertolami’s mentor-protégé vision to life. In June, the College launched a four-month pilot program that has the potential to reinvent the current clinical education model. The pilot represents the first phase of a plan to expand the College's patient care services to people in Brooklyn and the surrounding area. Designed to create new educational and patient care learning opportunities for students, the pilot program emphasizes collaborative efforts and synergy among teams of highly motivated students, faculty, and support personnel.

Since June 1, 10 rising D4 students have been participating in the pilot program, which originated at the Bluestone Center for Clinical Research and is being conducted in the Rosenthal Institute from July through September. Six to seven students a day work closely with two dental assistants, a part-time hygienist, and four general practice faculty members, two of whom are present every day. Using a private practice model, the students participate in patient and financial management, including scheduling and revenue collection, and learn to work as an interprofessional team and to deal with unanticipated challenges, such as treating emergency patients. Their educational experiences are further enriched through weekly seminars and group and individual mentoring.

Since as many as four students may be on rotations or have days off each week, students have the benefit of a 3 to 1 student-faculty ratio. This enables an extremely interactive and collegial relationship between students and faculty, one in which the faculty member works directly alongside the student, not as a checker, but as a hands-on, active teacher. The dynamic is very similar to what occurs on global outreaches. Given the success of the global outreach model in accelerating student learning and productivity, the 10 students were selected primarily from the cohort of students who participated in global outreaches during the 2018-2019 academic year. In addition to a closer, more collaborative and more comfortable relationship between students and faculty, there is also more interaction among students, the dental assistants, and the dental hygienist, who facilitates patient care.

After just two months, the pilot program is seeing more than three times the number of patients as the traditional DDS program and the participating students and faculty are having what they describe as optimal learning and teaching experiences.

Austin Le, '20, who participated in an NYU Dentistry Henry Schein Cares Global Student Outreach Program in Machias, Maine, in March 2019, is one of the 10 students in the pilot program. 

"From the student's perspective, the pilot model offers a more strategic approach to learning than the traditional clinical model," he says. "There is greater efficiency, which means that we're able to see more patients. We're also learning time management skills and have greater autonomy, which makes the experience challenging but not overwhelming, and the faculty supervising our work look at it holistically, rather than piecemeal," he adds.

Aida Hamdy Shalan, '20, learned about the Brooklyn pilot as a member of Dean Bertolami's "Reading for Value" group. She was thrilled about the concept and knew that she wanted to be part of it. "Initially," she says, "I felt that because I had not participated in global outreach, I might lag behind the other students. But I quickly realized that if I worked hard and really wanted to succeed, I would not have a problem.

"My high expectations for the program are being met," she adds. There is so much to like about it, especially working so closely with faculty. When you’re on the 'traditional' clinic floor, there are so many instances when faculty are not able to explain things to you fully, because there are so many students vying for their attention," she says.

I like the experience of having a real mentor next to me, not just a faculty member, and that’s what the pilot provides. The experience has convinced me that I want to go into dental education — to give something back.
     - Aida Hamdy Shalan, DDS '20

Rebecca Renulus, '20, who participated in an outreach to Cambodia in November 2018, agrees with her fellow students' comments and adds that "in contrast to the traditional clinics, in which we see two patients a day for two-hour appointments, in the Brooklyn pilot I'm able to decide on the best way and time to treat my patients, which gives me greater flexibility to accommodate their schedules. And they appreciate that very much. The experience has allowed me to grow and to measure my own growth. Yes, we cultivate our hand skills, but dentistry is so much more than that."

Andrew Hopkins, '20, who was recruited based on his performance on an outreach trip to Ecuador in January 2019, says that "If there's a procedure that I'm not yet comfortable with, the faculty member sits right next to me and assesses what I'm doing every step of the way, which provides me with a tremendous growth opportunity. That's very different from completing a procedure and looking for a faculty member to check it. I'm also getting great feedback from my patients, who love the speed with which their treatment proceeds. And the time-management training I'm receiving is preparing me for real-life practice. Today, for example, I'm seeing eight patients and providing a range of procedures. That’s the number of patients I would typically see in a week. Initially, it was a challenge for me, but now I've more than tripled the number of patients I see in a day. And making sure that I'm staying on schedule is making me a better dentist."

Dr. Suzette Stines is one of the faculty members participating in the pilot program. Dr. Stines, a clinical assistant professor of cariology and comprehensive care, calls the program "a truly remarkable concept, a dream come true for a faculty member." She says that "it provides an optimal way to teach DDS students because you get to work with them so intimately. You have the opportunity to assess the students' knowledge base and to discuss their foundational understanding of the overall treatment plan for the patient before you begin, so that they have a comprehensive view of the case with the outcome in mind, which is a fantastic opportunity in terms of teaching."

As they work, if there's something they're not proficient in, you can coach them and then let them work independently. As a result, the students gain proficiency at an astounding rate. I believe that this concept has the potential to change the entire dental education paradigm in an extremely positive way.
   - Suzette Stines, DDS, clinical assistant professor, Department of Cariology and Comprehensive Care

Dr. Kay Oen, clinical assistant professor of cariology and comprehensive care, says that the main thing that makes the program so special is that it is very individualized and interactive. "We're able to teach chairside and to teach actively," he says.

Because we don't have long lines of students waiting for us to check their procedures, students get more attention and learn more easily. Also, depending on the complexity of the case, and where appropriate, general practice faculty who have extensive experience and training in specialty procedures such as prosthodontics, oral surgery, and endodontics, are able to show students when it would be proper to perform such procedures.
   – Kay Oen, DDS, clinical assistant professor, Department of Cariology and Comprehensive Care

Patients are also very excited about the program. Amy Antenucci said that as a Medicaid recipient, she looked for dentists in her neighborhood who would accept her form of payment, but had a very unsatisfying experience. In April 2019, she decided to come to NYU and was invited to participate in the pilot program on the day of her initial visit. "It has been a fantastic experience," she says. "I have never cancelled an appointment; I have never needed pain medication. Everyone is wonderful — my student doctor, the faculty, they are all marvelous people, they work together so well, and I know that they have my best interests at heart. I just want to say 'thank you, thank you, thank you.' I tell people all the time, you need to get to NYU."

Thelma Genrette first began receiving dental care at NYU in 2011. "After that," she says," I didn’t come back. Then, last February, I decided that it was time to see the dentist and when I returned to NYU they greeted me warmly and told me that I was eligible to receive care in this new program. After having X-rays and receiving a treatment plan, I started treatment in June. I love that everyone confers with me about my treatment. Even though I don't understand the technical terms, I'm happy that they ask what I think. I feel very comfortable and enjoy every visit."

The College will launch an expanded version of the pilot program in early 2020, when a new comprehensive dental care facility in Downtown Brooklyn's City Point area will open to bring high-quality, low-cost treatment to adults and children in the area.

"Through the Brooklyn expansion," says Dean Bertolami, "we are reimagining dental education by giving students even more clinical experience than they have traditionally had at NYU, along with learning how to run a dental practice in a real-world environment. At the same time, we are empowering both the students and the faculty to work together as a true team. If this approach succeeds, and I am confident that it will, our plan is to adopt this educational model for other selected clinical teaching at the College, which will improve the dental education experience for our DDS students, as well as for our patients and faculty. In short, we will have proven that a different approach to dental education can work."