Vol. 35. No. 3-Summer
195
Issue
EDUCATIONAL PROGRAMS IN DENTAL PUBLIC HEALTH AT SCHOOLS OF PUBLIC HEALTH AS OF FALL 1973” By Lester E. Block, DDS, MPH**
Because the future leaders in dental public health are being educated in today’s academic institutions, particularly the schools of public health, an attempt was made to determine the type of programming in dental public health which was available at each accredited School of Public Health. A previously published report contained the preparatory portion of this investigation and described five impacts on the dentist’s graduate education: (1) the development of the American Board of Dental Public Health and the development of the specialty of dental public health; (2) the changes in the definition of “Public Health Dentist”; and (3) the requirements for being considered Board-eligible by the American Board of Dental Public Health, and for being considered as a specialist in dental public health by the Council on Dental Education of the American Dental Association; (4) the suggested content in dental public health for academic programs training public health dentists as published by The American Board of Dental Public Health and The Committee on Professional Education of the American Publjc Health Association; and (5) the status of training for dental public health in 1963. The report of a survey of the three facets investigated now will follow. They are (1) the administrative structure, faculty, curriculum, and minimum length of time required to complete the degree of Master of Public Health by a dentist and his required fieldexperience, if any, at each of the 19 accredited schools of public health; (2) a comparison of the level of programming in dental public health at schools of public health in 1963 and 1973; and (3) an examination of the programs in dental public health at the various schools to determine whether they follow the “Guidelines for Graduate Education in Dental Public Health‘” of the American Board of Dental Public Health and the American Public Health Association’s “Educational Qualifications of Public Health Dentists.”* The Method Used
Letters to request information regarding programs in dental public health and the forms for application were sent in August 1973 from a fictitious dentist to the directors of admission of all 19 of the then accredited schools of public healtht3 (See Table I). In October a second letter was sent to those schools which had not responded to the first letter within the eight weeks which had passed. All of the schools eventually responded to either the first or second letter. Most of the data presented were obtained in the written information received from the schools, particularly in the schools’ bulletins and the responding letters. When the information in a school’s response was either unclear or appeared to be incomplete, the school’s office of admissions was called by telephone and someone in that office then provided the information needed. No attempt was made to communicate with faculty or students at any school and no attempt was made to evaluate the quality of the programs in dental public health at the various schools. The reader should keep in mind that certain conclusions and suppositions had to be made from the available information which, it is hoped, are based upon an objective appraisal. The findings come from the published articles or the unpublished papers pre*A report, “The Development of Requirements for the Dentist in Public Health: a Review, 19451973,” describing how the requirements for the specialty of dental public health developed; appeared in the Winter Issue of the Journal for 1975. **Director, Programs in Dental Public Health and Public Health Administration, School of Public Health, University of Minnesota, 1325 Mayo Memorial Building, Minneapolis, Minnesota 55455. tThe University of Minnesota’s School of Public Health was considered to have responded, inasmuch as it usually does, fo the letters of inquiry from dentists.
*
196
J o u r n a l of Public H e a l t h Dentistry
sented, the written material included in the schools'* responses, the telephone calls made when appropriate to the offices of admissions, or from the personal knowledge gained during the investigation. Table I Accredited Schools of Public Health 1973 University of California at Berkeley, School of Public Health University of California at Los Angeles, School of Public Health Columbia University, School of Public Health Harvard University, School of Public Health University of Hawaii, School of Public Health University of Illinois, School of Public Health Johns Hopkins University, School of Hygiene and Public Health Loma Linda University, School of Public Health University of Michigan, School of Public Health University of Minnesota, School of Public Health University of North Carolina, School of Public Health University of Oklahoma, School of Health University of Pittsburgh, Graduate School of Public Health University of Puerto Rico, School of Public Health University of Texas at Houston, School of Public Health University of Toronto, School of Hygiene Tulane University, School of Public Health and Tropical Medicine University of Washington, School of Public Health and Community Medicine Yale University, Department of Epidemiology and Public Health The Findings To facilitate reporting the results from the survey, the findings now will be reported under four classified headings. 1. Type of Program in Dental Public Health (See Table 11)
From the bulletins of their schools, a total of seven schools can be said to have identifiable programs in dental public health. Two (Michigan and Minnesota) have identifiable and administratively independent programs. Two have identifiable nonadministratively independent programs (Loma Linda and North Carolina). Three have identifiable programs based in dental schools (Harvard, Hopkins, and Toronto), and 12 have no identifiable program in dental public health. Some of the other schools might have a program in dental public health although their bulletins identify no program. The scope of the programs at the seven schools varies widely. Michigan and Minnesota appear to have the most comprehensive programs. Twelve schools utilize a dental school to provide the input for dental public health, and the contributions of the dental schools also vary from a minor portion to the entire portion of the curriculum.
*The University of Minnesota's School of Public Health was considered to have responded, inasmuch as it usually does, to the letters of inquiry from dentists.
Vol. 35, No. 3-Summer
Issue
197 Table I1
Type of Dental Public Health Program; 1973 No Identifi-
School of Public Health Calif. at Berkeley
0
0
0
t
Calif. at Los Angeles
0
0
0
Columbia
0
0
0
+ +
Harvard
0
0
+
NA
Hawaii
0
0
Illinois
0
0
I
0
Johns Hopkins
0
0
I
0
.+
t
NA
Puerto Rico
0
0
Texas
0
0
Toronto
0
0
+
NA
Tulane
0
0
0
Washington
0
0
0
Yale
0
0
0
+ + +
TOTAL 19
2
2
3
12
Loma Linda Michigan Minnesota North Carolina Oklahoma Pittsburgh
0 = No or None
'+
I I I
NA
I
NA
I
"4
I
NA
I
NA
I
0
+ +
: t
+
= Yes or With
+
0
I
NA
t
Nonapplicable
2. Dental Public Health Faculty (See Table 111) Full-time Faculty. Of the 18 schools of Public Health from which data were obtained,* 14 schools have at least one public health dentist on their faculty either full-time or part-
time. Seven schools have full-time public health dentists on their faculty (a dentist with the
*Data on the faculty of the University of Puerto Rico were not included in its response. Because all courses are conducted in Spanish, further inquiry was not made.
Journal of Public Health Dentistry
198
Johns Hopkins
1
Chm. Dept. of Pub. Hlth. Admin.
0
13
Loma Linda
0
NA
1
0
3
14"
Prof. & Dir. Dental Pub. Hlth. Prog., Asst. Prof. of Dent. Pub. Hlth.
Michigan
2
Minnesota
1
Assoc. Prof. & Dir., Prog. in Dental Pub. Hlth.
6
0
North Carolina
1
Prof. & Dir. of Continuing Education
4
0
Oklahoma
0
NA
3
0
Pittsburgh
0
NA
3
1
Toronto
0
NA
2
0
Yale
1
Assoc. Prof., Hlth. Services Admin.
2
2g
8
NA
33
36
TOTAL
15
Vol. 35, No. 3-Summer
Issue
199
degree of MPH or an equivalent degree) and of the seven schools only Michigan and Minnesota have officially designated directors of the program in dental public health. Michigan has the only director assigned exclusively to such a program. Minnesota’s director also serves as Acting Director of the Program in Public Health Administration. The full-time public health dentist at Johns Hopkins is the Chairman of the Department of Public Health Administration; at North Carolina, the Director of Continuing Education; and at Illinois, the Chairman of the Department of Health Resources Management. Of the total of eight full-time public health dentists, only two spend all of their time on activities related to dental public health and five spend most of their time in activities not specifically related to dental public health. Part-time Faculty of Rank of Assistant Professor or Higher.* Of the 18 schools, 12 have part-time faculty of the rank of Assistant Professor or higher. It is impossible to decide from the data available what percent of their time is devoted to the school by the part-time faculty. There is a total of 33 part-time faculty in this category at the 12 schools. Of the 33 faculty four are social scientists and 29 are dentists. Part-time Faculty of Rank Lower than Instructor. Of the 18 schools, nine have 36 dentists as part-time faculty with a rank lower than that of Instructor. Of the 36 faculty, a minimum of 14 are nonresident lecturers who reside in a diflerent geographic area than the one in which the school is located. 3. Dental Public Health Courses Listed in the Bulletins Where Students Are Prepared for MPH (See Table IV) Of the 19 schools, 12 have at least one dental public health course listed. Michigan and Minnesota have the most courses listed, with nine each. Five schools list one course, and four list three courses. 4. Minimum Length of Time for Completion of Program for MPH and Required Field-Experience (See Table V) Of the 19 schools, 12 require a minimum of one academic year (usually SeptemberJune) for a dentist to complete his program for the MPH. Two schools require 11 months and five require one calendar year. Five schools require field experience, but two of the five waive this requirement if the dentist enters a residency program. Only one school, Columbia, would require a dentist not entering a residency program to spend more than a calendar year to complete the program for the MPH.
Some Discussion In the guidelines of 1963, “Education of Public Health Dentists in the United States and Canada,”4 two trends were stated. The first was the lengthening of programs for the degree of MPH to more than an academic year and the requirement of field-experience by schools of public health. In 1963, “at least three Schools of Public Health and possibly more,”4 required field experience. The second and more significant trend was
*Included in this category is any part-time public Health dentist on the school’s faculty and any nondentists listed as faculty in dental public health.
4
J o u r n a l of Public Health Dentistry
200
Table IV Number of Dental Public Health Courses Listed In School Bulletins ~~
Number of Dental Public Health Courses
School of Public Health Calif. at Berkeley
1
Calif. at Los Angeles
0
Columbia
3
~~
I I
Harvard Hawaii
3
1
Illinois
0
Johns Hopkins
3
Loma Linda
1
I
Michigan
9 9
Minnesota North Carolina
I
3
~~
0
Oklahoma
I
Pittsburgh
1
~~
Puerto Rico
0
Texas
0
~
Toronto
4
Tulane
0
Washington
0
Yale
1
TOTAL
19
39
Twelve out of 19 Schools of Public Health list 1 or more dental public health courses.
that schools of public health were beginning to acknowledge that dental public health had come of age, and had done so concretely by adding full-time dental public health specialists to their faculties.4 The progress which has been made in the curricula for dental public health since 1963 at schools of public health and in their employment of faculty for teaching dental public health should be of interest. In the discussion which follows the cited trends will be examined in relation to present teaching at the schools of public health. During the past year, with its inception of what has been called “The New Federalism,” a number of schools have reduced or changed the role of their faculty in dental public health in a way which must weaken their programs in dental public health. Meskin, preparing for his paper in 1973 on “The Effect of the New Federalism on
Vol. 35, No. 3-Summer
20 1
Issue
Table V Minimum Time Required for Completion of M.P.H. Program by a Dentist by School and Required Field Experience
Requires 1 academic year
Requires 11 months
Requires 1 Calendar year
Calif. at Berkeley Harvard Hawaii Johns Hopkins Loma Linda Oklahoma Pittsburgh Puerto Rico Texas Toronto Tulane Yale
Minnesota North Carolinae
Calif. at Los Angelesa Columbiab Illinois‘ Michigand Washington
12
2
5
TOTAL OF 19 SCHOOLS a. U.C.L.A. requires a 12 week summer field-experience. b. Columbia requires an additional field-experience after the completion of the calendar year of academic training. This requirement is waived for dentists entering residencyprograms. c. Illinois requires field-experience which is included during the calendar year. d. Michigan requires additional field-experience which can be included during the calendar year. This requirement is waived for dentists entering residency-programs. e. North Carolina requires 12 weeks of summer field-training which is included in the 11 months.
Schools of Public Health,”s interviewed the directors of the programs in dental public health at three schools of public health. One director indicated because of the tenuous status of his funds, that he had lost faculty to dental schools which could offer hard money and tenured positions. Another director was made Director of the Program in Continuing Education at the School of Public Health. He consented to continue to advise the dental public health students only because of his desire to maintain a dental program. The third director now serves also as Acting Director of the program in Public Health Administration and, therefore, does not have the same amount of time now to advise students of dental public health as formerly. These three directors agreed, if the trends in funding schools of public health continue, the present situation will become more severe and might result in the termination of identifiable programs of training for dental public health. The gains that have been made by some schools in getting full-time directors, who understand the needs of, and are able to advise the dental public health students in a meaningful manner, will be lost and the student will become just another member of the student-body at the school of public health.5
202
Journal of Public Health Dentistry
In 1963 14 schools of public health were accredited and two schools,* Michigan and North Carolina, had full-time dental public health f a c ~ l t y .Michigan ~ had two full-time faculty members and North Carolina had three. In the Fall of 1973, Michigan still had two and North Carolina had only one who now serves as the Director of Continuing Education. Of the 14 schools in 1963, four schools-Michigan, North Carolina, Harvard, and Toronto-had identifiable programs in dental public health.4 Today a total of seven out of 19 schools can be said to have identifiable programs in dental public health as described in the bulletins of their schools. It has been impossible to get accurate information about the programs in dental public health from the description in the schools’ bulletins, particularly when a program is not actually described, but courses and faculty only are listed. The best one can do, without conducting an extensive study through visits and interviews of students and faculty and observation of the curriculum operating at each school, is to estimate the kind of program which exists from the material which the schools make available. It then becomes necessary to decide upon certain elements in the program which can be considered essential and must, therefore, be available at a school in order to provide a viable program in dental public health. It seems from the study completed that two elements are essential in order to be able to state that there is more than a minimal curriculum in dental public health at a particular school. The first element is a faculty for teaching dental public health and the second is the availability of a reasonable number of dental public health courses or credits. Since the following schools have neither a faculty in dental public health nor courses in dental public health, one can say with some certainty that they have no program: Texas, Tulane, and Washington. California at Los Angeles, Illinois, Oklahoma, and Puerto Rico** do have a part-time faculty in dental public health, but no courses in dental public health, so they too must be considered without a program in dental public health. Four schools do not state that they have a program in dental public health, although they have some element of the essential requirements. They, however, cannot be considered as presenting a program in dental public health. Hawaii has one course listed, but no public health dentist on its faculty; Berkeley has two part-time faculty in dental public health, but only one course in dental public health is listed; Pittsburgh has four part-time faculty listed in dental public health, but only one course in dental public health is listed; and Yale has one full-time dentist on its faculty, but only one course in dental public health is listed. It appears, therefore, that 11 out of the 19 schools of public health must be considered as having no program in dental public health and seven of these 11 schools can be said to have little, if anything, in their curricula related to dental public health. In the eight remaining schools, a wide variation exists in the scope of the curriculum in dental public health. Loma Linda lists an identifiable program, but with only one course in dental public health and one part-time faculty member listed, the existence of an identifiable program there has to be questioned. It seems fair to state, from the information provided by the schools, that there are seven schools which have what can be termed as programs in dental public health. They are Columbia, Harvard, Johns Hopkins, Michigan, Minnesota, North Carolina, and Toronto. Of the seven, Michigan and Minnesota have administratively separate programs with full-time faculty in their Schools of Public Health as directors of the programs. Both programs have nine courses in dental public health listed in their bulletins, and it appears that these programs provide a broader curriculum than the other five programs.
*Refer to the previously listed article for a more detailed discussion. **Exact number unavailable.
Vol. 35, No. 3-Summer
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203
Of the five other programs, two (Johns Hopkins and Toronto) get all input of dental public health from an affiliated dental school, and one (Columbia) gets most of its input for dental public health from an affiliated dental school. Although they list fewer courses in dental public health than either Michigan or Minnesota (three courses at Columbia and Johns Hopkins and four at Toronto), the descriptions of courses seem to include the type of content which the American Board of Dental Public Health has suggested as desirable in its “Guidelines for Graduate Education in Dental Public Health.”* Of the remaining two schools, Harvard, which has a three-year joint graduate program in its School of Public Health and School of Dental Medicine, bases its program at the School of Public Health during the year for granting the degree of MPH; and North Carolina’s program is based essentially in its School of Public Health. The descriptions of courses in dental public health at both schools also seem to include the type of content which the Board’s “Guidelines” has described as desirable. Because data only on the faculty was collected in the 1963 study,4 it is possible to make limited comparisons only. In 1963, out of 14 schools of public health, only two schools had five full-time, public health dentists on their faculties. Michigan had two and North Carolina had three. Today, there are seven schools with a total of eight full-time faculty, although only three of the eight faculty spend the major portion of their time in activities related to dental public health. The reader now can determine the extent of progress since 1963. In 1963, three of the 14 schools had no dentist on the faculty while in 1973 four out of 19 schools had no dentist on their faculty. The number of part-time faculty listed since 1963, however, experienced a significant increase from 12 to 62. It still is doubtful that there has been a continuation of the trend to add full-time specialists in dental public health to the faculty for the purpose of implementing programs in dental public health. It appears also that the trend to increase the minimum length of time required for a dentist to complete his program for the MPH has not continued. Only seven of the 19 schools require a longer period of time than the traditional academic year, and only one school may require more than a calendar year. The trend of schools of public health to require field-experience has not continued. Only five of the 19 schools require field-experience. At this point, it also seems worth trying to determine if dentists who are students at schools of public health are being educated according to the American Board‘s “Guidelines” and the American Public Health Association’s “Educational Qualifications of Public Health Dentists.”* In the “Guidelines” four facets of instruction are identified in which dental public health students should receive training: (1) the methods for detecting and measuring the incidence and prevalence of all oral health problems; (2) the methods or skills required for the effective administration of programs for improving oral health; (3) the methods most suited for diagnosing, preventing, intercepting, and controlling specific oral diseases, and a logical pattern for evaluating the effectiveness of these methods; and (4) the approaches or methods for gaining knowledge of the international, national, state, and local resources that can be utilized in programs for the improvement of oral health.’ Only seven schools of public health have the faculty and the curriculum to deliver a program which would cover these four facets. Certain of the following criteria from the section on Guidelines for “Administration of the Educational Program” have not been fulfilled: “Whenever dentists are accepted for instruction that leads to an advanced degree in public health, two requirements are overdue and now should be met by all schools of public health which enroll dentists: (1) Instruction in dental public health should be provided; and (2) at least one certified specialist in dental public health should be a full-time member of the faculty.”’
--
*Refer to the previously published report for a more detailed discussion of the content in ‘‘Guidelines.”
204
J o u r n a l of Public Health Dentistry
If the present crisis in funding for schools of public health continues, achievement of these goals will be a long way off. Before the crisis, however, schools were not utilizing their dollars to add full-time faculty in dental public health. With this pattern so well established, it is doubtful that schools now will expend their dwindling resources to support faculty in dental public health unless that faculty also can function in other capacities at the schools. Whether it is necessary for each school of public health to establish its own faculty or program in dental public health is open to question. Some schools have been exploring the possibility of working together to offer joint-programs. When existing resources are decreased, the administration either can weaken all programs or weaken or eliminate selected programs. It seems more sensible for schools not to weaken their strongest programs, but to eliminate their weakest ones. If schools could plan together and cooperate in redistributing their resources, the total number of programs a t each school might be reduced, but each remaining separate program could be strengthened. If the objective of dental public health educators is to make certain that public health dentists actually receive an education which includes the four facets of instruction, there are several steps which could be taken to help achieve that objective. Guidelines might be established by the Council o n Dental Education for accrediting dental public health educational programs just as it accredits the educational programs of other dental specialties. In order for a dentist to be considered a specialist in dental public health, it would be necessary for him to have attended a n educational institution which met the criteria established by the Council for dental public health curriculum and faculty. N o longer would accreditation for a School of Public Health by the American Public Health Association be accepted automatically by the Council. Such action, if it could be accomplished, would eliminate all but the qualifying schools of public health from approval by the Council as conducting acceptable programs in dental public health. This action might encourage a school which does not now have a curriculum or faculty in dental public health either to establish a program or to make a decision not to have one. It also might lead to a strengthening of those programs already in existence because dentists probably would want to apply only to those schools which have programs approved by the American Dental Association. The total effect of this action might be either a n increase in the number and scope of programs in dental public health a t schools of public health or the strengthening of the current programs. At this time it is unlikely that many of the schools of public health are providing programs for dentists which meet the standards established in the American Board‘s “Guidelines” or the American Public Health Association’s “Educational Qualifications of Public Health Dentists.” It also is time to question seriously the blanket acceptance, by either the Council on Dental Education or the American Board of Dental Public Health, of a year’s training a t a school of public health as meeting the academic requirements of specializing in dental public health.
Summarizing A letter of inquiry from a fictitious dentist, requesting applications and information regarding training in dental public health, was sent to each of the 19 accredited Schools of Public Health. The purpose of the survey was to determine the manner in which the schools respond to a letter of inquiry from a dentist and to determine, from the material included in the response, what type of program in dental public health, if any, each school had. All 19 schools responded, but the type and quality of the responses varied greatly. Some schools answered the questions fully and others ignored them. From the bulletins of the schools and other material contained in the responses, seven schools were determined to have what could be termed viable programs in dental public health. Two of the seven programs are administratively independent with full-time faculty
*
Vol. 35, No. 3-Summer
Issue
205
as directors of their programs; three of the programs receive their major input in dental public health from an affiliated dental school; one program’s input of dental public health is provided by the school of public health; and one program has an affiliation with a dental school, but the major portion of the input for dental public health during the year of preparation for the degree of MPH is provided in the school of public health. There are seven schools of public health with eight full-time faculty who are public health dentists, although only three of the faculty spend a substantial portion of their time in activities related to dental public health. Five schools have no public health dentist on the faculty and they have a total of 33 part-time faculty at the rank of assistant professor or higher and a total of 36 part-time faculty with a rank lower than instructor. Twelve of the schools of public health still require only a minimum of an academic year for a dentist to receive the degree of MPH and only one school requires more than a calendar year. Only five schools require field-experience in order for a dentist to receive his degree of MPH. Most schools, it appears, do not provide a program for dentists which meets the standards established by the American Public Health Association or the American Board of Dental Public Health. It is time to question the blanket acceptance by the Council on Dental Education of the American Public Health Association’s accreditation of Schools of Public Health for meeting the academic requirements in the’specialty of dental public health. Note. Readers wishing to receive the complete description of the programs in dental public health at each school of public health may get it by writing to Dr. Block for a copy of the “Directory of Dental Health Programs at Schools of Public Health.”
public
Bibliography I . Guidelines for graduate education in dental public health. Ann Arbor, American Board of Dental Public Health, May 1970. 10 p. duplicated. 2. American Public Health Association, Committee on Professional Accreditation. Educational qualifications of public health dentists. Am. J. Pub. Health, 57:682-91, Apr. 1967. 3. Schools of public health in the USA and Canada. Washington, American Public Health Association, Jan. 1973. I p. duplicated. 4. Striffler. D. F. Education of public health dentists in the United States and Canada. Am. Dent. A. J., 66:758-62, June 1963. 5 . Meskin, L. H. The effect of the new federalism on schools of public health. Paper presented at Annual Meeting of the American Public Health Association, Dental Health Section, in San Francisco, 1973. [Editor’s note: a shortened version of that paper appears in this issue.]
Hypertension Death or chronic disability are the greatest tragedies when they could have been prevented. High blood pressure is a common, often unsuspected precursor to these conditions and should be of concern to every public health dentist. Everyone should ensure that they and their families are periodically checked, that the American Dental Association policies about blood pressure surveillance are supported and that informational materials are widely distributed. Informational materials appropriate to many media may be obtained by writing to the -High BIood Pressure Information Center 120/80 National Institute of Health Bethesda, Maryland 20014
.
195
Issue
EDUCATIONAL PROGRAMS IN DENTAL PUBLIC HEALTH AT SCHOOLS OF PUBLIC HEALTH AS OF FALL 1973” By Lester E. Block, DDS, MPH**
Because the future leaders in dental public health are being educated in today’s academic institutions, particularly the schools of public health, an attempt was made to determine the type of programming in dental public health which was available at each accredited School of Public Health. A previously published report contained the preparatory portion of this investigation and described five impacts on the dentist’s graduate education: (1) the development of the American Board of Dental Public Health and the development of the specialty of dental public health; (2) the changes in the definition of “Public Health Dentist”; and (3) the requirements for being considered Board-eligible by the American Board of Dental Public Health, and for being considered as a specialist in dental public health by the Council on Dental Education of the American Dental Association; (4) the suggested content in dental public health for academic programs training public health dentists as published by The American Board of Dental Public Health and The Committee on Professional Education of the American Publjc Health Association; and (5) the status of training for dental public health in 1963. The report of a survey of the three facets investigated now will follow. They are (1) the administrative structure, faculty, curriculum, and minimum length of time required to complete the degree of Master of Public Health by a dentist and his required fieldexperience, if any, at each of the 19 accredited schools of public health; (2) a comparison of the level of programming in dental public health at schools of public health in 1963 and 1973; and (3) an examination of the programs in dental public health at the various schools to determine whether they follow the “Guidelines for Graduate Education in Dental Public Health‘” of the American Board of Dental Public Health and the American Public Health Association’s “Educational Qualifications of Public Health Dentists.”* The Method Used
Letters to request information regarding programs in dental public health and the forms for application were sent in August 1973 from a fictitious dentist to the directors of admission of all 19 of the then accredited schools of public healtht3 (See Table I). In October a second letter was sent to those schools which had not responded to the first letter within the eight weeks which had passed. All of the schools eventually responded to either the first or second letter. Most of the data presented were obtained in the written information received from the schools, particularly in the schools’ bulletins and the responding letters. When the information in a school’s response was either unclear or appeared to be incomplete, the school’s office of admissions was called by telephone and someone in that office then provided the information needed. No attempt was made to communicate with faculty or students at any school and no attempt was made to evaluate the quality of the programs in dental public health at the various schools. The reader should keep in mind that certain conclusions and suppositions had to be made from the available information which, it is hoped, are based upon an objective appraisal. The findings come from the published articles or the unpublished papers pre*A report, “The Development of Requirements for the Dentist in Public Health: a Review, 19451973,” describing how the requirements for the specialty of dental public health developed; appeared in the Winter Issue of the Journal for 1975. **Director, Programs in Dental Public Health and Public Health Administration, School of Public Health, University of Minnesota, 1325 Mayo Memorial Building, Minneapolis, Minnesota 55455. tThe University of Minnesota’s School of Public Health was considered to have responded, inasmuch as it usually does, fo the letters of inquiry from dentists.
*
196
J o u r n a l of Public H e a l t h Dentistry
sented, the written material included in the schools'* responses, the telephone calls made when appropriate to the offices of admissions, or from the personal knowledge gained during the investigation. Table I Accredited Schools of Public Health 1973 University of California at Berkeley, School of Public Health University of California at Los Angeles, School of Public Health Columbia University, School of Public Health Harvard University, School of Public Health University of Hawaii, School of Public Health University of Illinois, School of Public Health Johns Hopkins University, School of Hygiene and Public Health Loma Linda University, School of Public Health University of Michigan, School of Public Health University of Minnesota, School of Public Health University of North Carolina, School of Public Health University of Oklahoma, School of Health University of Pittsburgh, Graduate School of Public Health University of Puerto Rico, School of Public Health University of Texas at Houston, School of Public Health University of Toronto, School of Hygiene Tulane University, School of Public Health and Tropical Medicine University of Washington, School of Public Health and Community Medicine Yale University, Department of Epidemiology and Public Health The Findings To facilitate reporting the results from the survey, the findings now will be reported under four classified headings. 1. Type of Program in Dental Public Health (See Table 11)
From the bulletins of their schools, a total of seven schools can be said to have identifiable programs in dental public health. Two (Michigan and Minnesota) have identifiable and administratively independent programs. Two have identifiable nonadministratively independent programs (Loma Linda and North Carolina). Three have identifiable programs based in dental schools (Harvard, Hopkins, and Toronto), and 12 have no identifiable program in dental public health. Some of the other schools might have a program in dental public health although their bulletins identify no program. The scope of the programs at the seven schools varies widely. Michigan and Minnesota appear to have the most comprehensive programs. Twelve schools utilize a dental school to provide the input for dental public health, and the contributions of the dental schools also vary from a minor portion to the entire portion of the curriculum.
*The University of Minnesota's School of Public Health was considered to have responded, inasmuch as it usually does, to the letters of inquiry from dentists.
Vol. 35, No. 3-Summer
Issue
197 Table I1
Type of Dental Public Health Program; 1973 No Identifi-
School of Public Health Calif. at Berkeley
0
0
0
t
Calif. at Los Angeles
0
0
0
Columbia
0
0
0
+ +
Harvard
0
0
+
NA
Hawaii
0
0
Illinois
0
0
I
0
Johns Hopkins
0
0
I
0
.+
t
NA
Puerto Rico
0
0
Texas
0
0
Toronto
0
0
+
NA
Tulane
0
0
0
Washington
0
0
0
Yale
0
0
0
+ + +
TOTAL 19
2
2
3
12
Loma Linda Michigan Minnesota North Carolina Oklahoma Pittsburgh
0 = No or None
'+
I I I
NA
I
NA
I
"4
I
NA
I
NA
I
0
+ +
: t
+
= Yes or With
+
0
I
NA
t
Nonapplicable
2. Dental Public Health Faculty (See Table 111) Full-time Faculty. Of the 18 schools of Public Health from which data were obtained,* 14 schools have at least one public health dentist on their faculty either full-time or part-
time. Seven schools have full-time public health dentists on their faculty (a dentist with the
*Data on the faculty of the University of Puerto Rico were not included in its response. Because all courses are conducted in Spanish, further inquiry was not made.
Journal of Public Health Dentistry
198
Johns Hopkins
1
Chm. Dept. of Pub. Hlth. Admin.
0
13
Loma Linda
0
NA
1
0
3
14"
Prof. & Dir. Dental Pub. Hlth. Prog., Asst. Prof. of Dent. Pub. Hlth.
Michigan
2
Minnesota
1
Assoc. Prof. & Dir., Prog. in Dental Pub. Hlth.
6
0
North Carolina
1
Prof. & Dir. of Continuing Education
4
0
Oklahoma
0
NA
3
0
Pittsburgh
0
NA
3
1
Toronto
0
NA
2
0
Yale
1
Assoc. Prof., Hlth. Services Admin.
2
2g
8
NA
33
36
TOTAL
15
Vol. 35, No. 3-Summer
Issue
199
degree of MPH or an equivalent degree) and of the seven schools only Michigan and Minnesota have officially designated directors of the program in dental public health. Michigan has the only director assigned exclusively to such a program. Minnesota’s director also serves as Acting Director of the Program in Public Health Administration. The full-time public health dentist at Johns Hopkins is the Chairman of the Department of Public Health Administration; at North Carolina, the Director of Continuing Education; and at Illinois, the Chairman of the Department of Health Resources Management. Of the total of eight full-time public health dentists, only two spend all of their time on activities related to dental public health and five spend most of their time in activities not specifically related to dental public health. Part-time Faculty of Rank of Assistant Professor or Higher.* Of the 18 schools, 12 have part-time faculty of the rank of Assistant Professor or higher. It is impossible to decide from the data available what percent of their time is devoted to the school by the part-time faculty. There is a total of 33 part-time faculty in this category at the 12 schools. Of the 33 faculty four are social scientists and 29 are dentists. Part-time Faculty of Rank Lower than Instructor. Of the 18 schools, nine have 36 dentists as part-time faculty with a rank lower than that of Instructor. Of the 36 faculty, a minimum of 14 are nonresident lecturers who reside in a diflerent geographic area than the one in which the school is located. 3. Dental Public Health Courses Listed in the Bulletins Where Students Are Prepared for MPH (See Table IV) Of the 19 schools, 12 have at least one dental public health course listed. Michigan and Minnesota have the most courses listed, with nine each. Five schools list one course, and four list three courses. 4. Minimum Length of Time for Completion of Program for MPH and Required Field-Experience (See Table V) Of the 19 schools, 12 require a minimum of one academic year (usually SeptemberJune) for a dentist to complete his program for the MPH. Two schools require 11 months and five require one calendar year. Five schools require field experience, but two of the five waive this requirement if the dentist enters a residency program. Only one school, Columbia, would require a dentist not entering a residency program to spend more than a calendar year to complete the program for the MPH.
Some Discussion In the guidelines of 1963, “Education of Public Health Dentists in the United States and Canada,”4 two trends were stated. The first was the lengthening of programs for the degree of MPH to more than an academic year and the requirement of field-experience by schools of public health. In 1963, “at least three Schools of Public Health and possibly more,”4 required field experience. The second and more significant trend was
*Included in this category is any part-time public Health dentist on the school’s faculty and any nondentists listed as faculty in dental public health.
4
J o u r n a l of Public Health Dentistry
200
Table IV Number of Dental Public Health Courses Listed In School Bulletins ~~
Number of Dental Public Health Courses
School of Public Health Calif. at Berkeley
1
Calif. at Los Angeles
0
Columbia
3
~~
I I
Harvard Hawaii
3
1
Illinois
0
Johns Hopkins
3
Loma Linda
1
I
Michigan
9 9
Minnesota North Carolina
I
3
~~
0
Oklahoma
I
Pittsburgh
1
~~
Puerto Rico
0
Texas
0
~
Toronto
4
Tulane
0
Washington
0
Yale
1
TOTAL
19
39
Twelve out of 19 Schools of Public Health list 1 or more dental public health courses.
that schools of public health were beginning to acknowledge that dental public health had come of age, and had done so concretely by adding full-time dental public health specialists to their faculties.4 The progress which has been made in the curricula for dental public health since 1963 at schools of public health and in their employment of faculty for teaching dental public health should be of interest. In the discussion which follows the cited trends will be examined in relation to present teaching at the schools of public health. During the past year, with its inception of what has been called “The New Federalism,” a number of schools have reduced or changed the role of their faculty in dental public health in a way which must weaken their programs in dental public health. Meskin, preparing for his paper in 1973 on “The Effect of the New Federalism on
Vol. 35, No. 3-Summer
20 1
Issue
Table V Minimum Time Required for Completion of M.P.H. Program by a Dentist by School and Required Field Experience
Requires 1 academic year
Requires 11 months
Requires 1 Calendar year
Calif. at Berkeley Harvard Hawaii Johns Hopkins Loma Linda Oklahoma Pittsburgh Puerto Rico Texas Toronto Tulane Yale
Minnesota North Carolinae
Calif. at Los Angelesa Columbiab Illinois‘ Michigand Washington
12
2
5
TOTAL OF 19 SCHOOLS a. U.C.L.A. requires a 12 week summer field-experience. b. Columbia requires an additional field-experience after the completion of the calendar year of academic training. This requirement is waived for dentists entering residencyprograms. c. Illinois requires field-experience which is included during the calendar year. d. Michigan requires additional field-experience which can be included during the calendar year. This requirement is waived for dentists entering residency-programs. e. North Carolina requires 12 weeks of summer field-training which is included in the 11 months.
Schools of Public Health,”s interviewed the directors of the programs in dental public health at three schools of public health. One director indicated because of the tenuous status of his funds, that he had lost faculty to dental schools which could offer hard money and tenured positions. Another director was made Director of the Program in Continuing Education at the School of Public Health. He consented to continue to advise the dental public health students only because of his desire to maintain a dental program. The third director now serves also as Acting Director of the program in Public Health Administration and, therefore, does not have the same amount of time now to advise students of dental public health as formerly. These three directors agreed, if the trends in funding schools of public health continue, the present situation will become more severe and might result in the termination of identifiable programs of training for dental public health. The gains that have been made by some schools in getting full-time directors, who understand the needs of, and are able to advise the dental public health students in a meaningful manner, will be lost and the student will become just another member of the student-body at the school of public health.5
202
Journal of Public Health Dentistry
In 1963 14 schools of public health were accredited and two schools,* Michigan and North Carolina, had full-time dental public health f a c ~ l t y .Michigan ~ had two full-time faculty members and North Carolina had three. In the Fall of 1973, Michigan still had two and North Carolina had only one who now serves as the Director of Continuing Education. Of the 14 schools in 1963, four schools-Michigan, North Carolina, Harvard, and Toronto-had identifiable programs in dental public health.4 Today a total of seven out of 19 schools can be said to have identifiable programs in dental public health as described in the bulletins of their schools. It has been impossible to get accurate information about the programs in dental public health from the description in the schools’ bulletins, particularly when a program is not actually described, but courses and faculty only are listed. The best one can do, without conducting an extensive study through visits and interviews of students and faculty and observation of the curriculum operating at each school, is to estimate the kind of program which exists from the material which the schools make available. It then becomes necessary to decide upon certain elements in the program which can be considered essential and must, therefore, be available at a school in order to provide a viable program in dental public health. It seems from the study completed that two elements are essential in order to be able to state that there is more than a minimal curriculum in dental public health at a particular school. The first element is a faculty for teaching dental public health and the second is the availability of a reasonable number of dental public health courses or credits. Since the following schools have neither a faculty in dental public health nor courses in dental public health, one can say with some certainty that they have no program: Texas, Tulane, and Washington. California at Los Angeles, Illinois, Oklahoma, and Puerto Rico** do have a part-time faculty in dental public health, but no courses in dental public health, so they too must be considered without a program in dental public health. Four schools do not state that they have a program in dental public health, although they have some element of the essential requirements. They, however, cannot be considered as presenting a program in dental public health. Hawaii has one course listed, but no public health dentist on its faculty; Berkeley has two part-time faculty in dental public health, but only one course in dental public health is listed; Pittsburgh has four part-time faculty listed in dental public health, but only one course in dental public health is listed; and Yale has one full-time dentist on its faculty, but only one course in dental public health is listed. It appears, therefore, that 11 out of the 19 schools of public health must be considered as having no program in dental public health and seven of these 11 schools can be said to have little, if anything, in their curricula related to dental public health. In the eight remaining schools, a wide variation exists in the scope of the curriculum in dental public health. Loma Linda lists an identifiable program, but with only one course in dental public health and one part-time faculty member listed, the existence of an identifiable program there has to be questioned. It seems fair to state, from the information provided by the schools, that there are seven schools which have what can be termed as programs in dental public health. They are Columbia, Harvard, Johns Hopkins, Michigan, Minnesota, North Carolina, and Toronto. Of the seven, Michigan and Minnesota have administratively separate programs with full-time faculty in their Schools of Public Health as directors of the programs. Both programs have nine courses in dental public health listed in their bulletins, and it appears that these programs provide a broader curriculum than the other five programs.
*Refer to the previously listed article for a more detailed discussion. **Exact number unavailable.
Vol. 35, No. 3-Summer
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Of the five other programs, two (Johns Hopkins and Toronto) get all input of dental public health from an affiliated dental school, and one (Columbia) gets most of its input for dental public health from an affiliated dental school. Although they list fewer courses in dental public health than either Michigan or Minnesota (three courses at Columbia and Johns Hopkins and four at Toronto), the descriptions of courses seem to include the type of content which the American Board of Dental Public Health has suggested as desirable in its “Guidelines for Graduate Education in Dental Public Health.”* Of the remaining two schools, Harvard, which has a three-year joint graduate program in its School of Public Health and School of Dental Medicine, bases its program at the School of Public Health during the year for granting the degree of MPH; and North Carolina’s program is based essentially in its School of Public Health. The descriptions of courses in dental public health at both schools also seem to include the type of content which the Board’s “Guidelines” has described as desirable. Because data only on the faculty was collected in the 1963 study,4 it is possible to make limited comparisons only. In 1963, out of 14 schools of public health, only two schools had five full-time, public health dentists on their faculties. Michigan had two and North Carolina had three. Today, there are seven schools with a total of eight full-time faculty, although only three of the eight faculty spend the major portion of their time in activities related to dental public health. The reader now can determine the extent of progress since 1963. In 1963, three of the 14 schools had no dentist on the faculty while in 1973 four out of 19 schools had no dentist on their faculty. The number of part-time faculty listed since 1963, however, experienced a significant increase from 12 to 62. It still is doubtful that there has been a continuation of the trend to add full-time specialists in dental public health to the faculty for the purpose of implementing programs in dental public health. It appears also that the trend to increase the minimum length of time required for a dentist to complete his program for the MPH has not continued. Only seven of the 19 schools require a longer period of time than the traditional academic year, and only one school may require more than a calendar year. The trend of schools of public health to require field-experience has not continued. Only five of the 19 schools require field-experience. At this point, it also seems worth trying to determine if dentists who are students at schools of public health are being educated according to the American Board‘s “Guidelines” and the American Public Health Association’s “Educational Qualifications of Public Health Dentists.”* In the “Guidelines” four facets of instruction are identified in which dental public health students should receive training: (1) the methods for detecting and measuring the incidence and prevalence of all oral health problems; (2) the methods or skills required for the effective administration of programs for improving oral health; (3) the methods most suited for diagnosing, preventing, intercepting, and controlling specific oral diseases, and a logical pattern for evaluating the effectiveness of these methods; and (4) the approaches or methods for gaining knowledge of the international, national, state, and local resources that can be utilized in programs for the improvement of oral health.’ Only seven schools of public health have the faculty and the curriculum to deliver a program which would cover these four facets. Certain of the following criteria from the section on Guidelines for “Administration of the Educational Program” have not been fulfilled: “Whenever dentists are accepted for instruction that leads to an advanced degree in public health, two requirements are overdue and now should be met by all schools of public health which enroll dentists: (1) Instruction in dental public health should be provided; and (2) at least one certified specialist in dental public health should be a full-time member of the faculty.”’
--
*Refer to the previously published report for a more detailed discussion of the content in ‘‘Guidelines.”
204
J o u r n a l of Public Health Dentistry
If the present crisis in funding for schools of public health continues, achievement of these goals will be a long way off. Before the crisis, however, schools were not utilizing their dollars to add full-time faculty in dental public health. With this pattern so well established, it is doubtful that schools now will expend their dwindling resources to support faculty in dental public health unless that faculty also can function in other capacities at the schools. Whether it is necessary for each school of public health to establish its own faculty or program in dental public health is open to question. Some schools have been exploring the possibility of working together to offer joint-programs. When existing resources are decreased, the administration either can weaken all programs or weaken or eliminate selected programs. It seems more sensible for schools not to weaken their strongest programs, but to eliminate their weakest ones. If schools could plan together and cooperate in redistributing their resources, the total number of programs a t each school might be reduced, but each remaining separate program could be strengthened. If the objective of dental public health educators is to make certain that public health dentists actually receive an education which includes the four facets of instruction, there are several steps which could be taken to help achieve that objective. Guidelines might be established by the Council o n Dental Education for accrediting dental public health educational programs just as it accredits the educational programs of other dental specialties. In order for a dentist to be considered a specialist in dental public health, it would be necessary for him to have attended a n educational institution which met the criteria established by the Council for dental public health curriculum and faculty. N o longer would accreditation for a School of Public Health by the American Public Health Association be accepted automatically by the Council. Such action, if it could be accomplished, would eliminate all but the qualifying schools of public health from approval by the Council as conducting acceptable programs in dental public health. This action might encourage a school which does not now have a curriculum or faculty in dental public health either to establish a program or to make a decision not to have one. It also might lead to a strengthening of those programs already in existence because dentists probably would want to apply only to those schools which have programs approved by the American Dental Association. The total effect of this action might be either a n increase in the number and scope of programs in dental public health a t schools of public health or the strengthening of the current programs. At this time it is unlikely that many of the schools of public health are providing programs for dentists which meet the standards established in the American Board‘s “Guidelines” or the American Public Health Association’s “Educational Qualifications of Public Health Dentists.” It also is time to question seriously the blanket acceptance, by either the Council on Dental Education or the American Board of Dental Public Health, of a year’s training a t a school of public health as meeting the academic requirements of specializing in dental public health.
Summarizing A letter of inquiry from a fictitious dentist, requesting applications and information regarding training in dental public health, was sent to each of the 19 accredited Schools of Public Health. The purpose of the survey was to determine the manner in which the schools respond to a letter of inquiry from a dentist and to determine, from the material included in the response, what type of program in dental public health, if any, each school had. All 19 schools responded, but the type and quality of the responses varied greatly. Some schools answered the questions fully and others ignored them. From the bulletins of the schools and other material contained in the responses, seven schools were determined to have what could be termed viable programs in dental public health. Two of the seven programs are administratively independent with full-time faculty
*
Vol. 35, No. 3-Summer
Issue
205
as directors of their programs; three of the programs receive their major input in dental public health from an affiliated dental school; one program’s input of dental public health is provided by the school of public health; and one program has an affiliation with a dental school, but the major portion of the input for dental public health during the year of preparation for the degree of MPH is provided in the school of public health. There are seven schools of public health with eight full-time faculty who are public health dentists, although only three of the faculty spend a substantial portion of their time in activities related to dental public health. Five schools have no public health dentist on the faculty and they have a total of 33 part-time faculty at the rank of assistant professor or higher and a total of 36 part-time faculty with a rank lower than instructor. Twelve of the schools of public health still require only a minimum of an academic year for a dentist to receive the degree of MPH and only one school requires more than a calendar year. Only five schools require field-experience in order for a dentist to receive his degree of MPH. Most schools, it appears, do not provide a program for dentists which meets the standards established by the American Public Health Association or the American Board of Dental Public Health. It is time to question the blanket acceptance by the Council on Dental Education of the American Public Health Association’s accreditation of Schools of Public Health for meeting the academic requirements in the’specialty of dental public health. Note. Readers wishing to receive the complete description of the programs in dental public health at each school of public health may get it by writing to Dr. Block for a copy of the “Directory of Dental Health Programs at Schools of Public Health.”
public
Bibliography I . Guidelines for graduate education in dental public health. Ann Arbor, American Board of Dental Public Health, May 1970. 10 p. duplicated. 2. American Public Health Association, Committee on Professional Accreditation. Educational qualifications of public health dentists. Am. J. Pub. Health, 57:682-91, Apr. 1967. 3. Schools of public health in the USA and Canada. Washington, American Public Health Association, Jan. 1973. I p. duplicated. 4. Striffler. D. F. Education of public health dentists in the United States and Canada. Am. Dent. A. J., 66:758-62, June 1963. 5 . Meskin, L. H. The effect of the new federalism on schools of public health. Paper presented at Annual Meeting of the American Public Health Association, Dental Health Section, in San Francisco, 1973. [Editor’s note: a shortened version of that paper appears in this issue.]
Hypertension Death or chronic disability are the greatest tragedies when they could have been prevented. High blood pressure is a common, often unsuspected precursor to these conditions and should be of concern to every public health dentist. Everyone should ensure that they and their families are periodically checked, that the American Dental Association policies about blood pressure surveillance are supported and that informational materials are widely distributed. Informational materials appropriate to many media may be obtained by writing to the -High BIood Pressure Information Center 120/80 National Institute of Health Bethesda, Maryland 20014
.
