Keeping the conversation going

Educating new members of the dental team was the focus of a Jan. 27-28 forum that brought 22 representatives of the ADA and American Dental Education Association to ADA Headquarters.

The goal of ADA/ADEA Workgroup: Education of New Dental Team Members was not to take any specific action, but rather to open the lines of communication between the two associations on a complex, timely issue.

“Undoubtedly, additional new team members will be developed in the future,” Dr. Ron Tankersley, ADA president, said in an address to the group. “Before any new models are conceived, a discussion between the practice community and educators could be helpful. The question is, if we were developing new team members from scratch, what would be the appropriate training and education for the different levels of scope and supervision proposed for them?”

An expansion of the allied dental workforce has been debated and studied in several states and regions as a potential solution to access needs for underserved patients. The ADA is now pilot-testing the Community Dental Health Coordinator workforce model in three locations; however, there is little consensus on most workforce models that have been proposed.

ADEA has no position on workforce models, Dr. Hunt said in his Jan. 27 address. “Other parties will determine workforce models and we will educate them.”

That new dental team members are already being educated and trained compels both associations to better inform one another about models that have been implemented, are under consideration or may be considered in the future; and identify issues to be addressed and resolved from the perspectives of the private practice and education communities.

“This is not a problem that will go away,” added Dr. Ronald Hunt, ADEA president. “The problem is access to care. One solution is to beef up the government funded safety net but that鈥檚 not happening right now. The fact is, the public sees an access problem and policymakers will try to correct it.”

The workgroup was conceived by Dr. Tankersley and Dr. Hunt. Until this year Dr. Hunt was the dean of the Virginia Commonwealth University School of Dentistry, where Dr. Tankersley is also a part-time faculty member. They also happen to be serving as presidents of ADA and ADEA at the same time.

“Ron and I began talking about the different types of providers that are being educated around the country and the fact that often, the education and training do not seem to be appropriate for what the providers are doing,” said Dr. Tankersley. “There ought to be some sort of protocol for education and training, and it should be according to the scope of practice and level of supervision.

“As we talked, it occurred to us that this would be a great opportunity to bring private practitioners together with educators to discuss needs so that when allied team members are created, it’s done in a more cost effective and logical way,” said Dr. Tankersley.

The event began as “a vehicle to bring our associations together,” added Dr. Hunt. “The goal would not be to come out with specific outcomes but a consciousness-raising exercise that provides a format for association leaders to talk openly.”

Speakers delivered presentations on new dental team members to promote a shared understanding between the two associations, followed by breakout sessions that enabled participants to explore critical questions and issues related to the education of new dental team members from both the educators’ and practitioners’ perspectives.

Dr. Tankersley emphasized that closer looks at several new workforce models were given “not to debate which existing models we individually prefer. We don鈥檛 expect consensus on many of these issues even within our respective groups, but rather to gain a better appreciation for the relationship between education and training to the scope of practice and type of supervision,” he said.

Presentation topics included:

• experiences and lessons learned in new health professions workforce models, with specific focus on nurse practitioners and physician assistants, by Carole Anderson, Ph.D., dean of the Ohio State University College of Dentistry;
• the case for the development of new dental team members to address access to care issues from a public/consumer advocate’s perspective by Shelly Gehshan, director of the Pew Children鈥檚 Dental Campaign, Pew Charitable Trusts.
• four new dental team members and issues related to their education and training, including the Minnesota dental therapist (by Dr. Patrick Lloyd, dean of the University of Minnesota School of Dentistry); the Community Dental Health Coordinator (by Dr. Stephen Young, dean of the University of Oklahoma College of Dentistry, and Dr. Gary Davis, vice chair of the Council on Access, Prevention and Interprofessional Relations and chair of the CDHC education committee); the military’s expanded function dental assistant model (by Col. Norman Ott, U.S. Army); and the proposed Maine dental therapist model (by Dr. James Schmidt, a member of the Council on Dental Education and Licensure and past president of the Maine Dental Association).

Included among the themes explored by the ADA/ADEA workgroup were:

• the need for increased understanding of the access to care problem to identify effective strategies for responding to this challenge;
• more consistency and clarity in terminology (e.g., midlevels, new dental team members, dental therapists, new oral health care practitioners, etc.) and data elements (e.g., methods of reporting prerequisites, content, clock hours, competencies, length of program) to promote a shared understanding;
• the likely need for multiple workforce models to address the differing access to care challenges and state needs. Different access challenges exist in different populations and settings. However, the profession should be aware of the challenges of creating too many different models in terms of educational standards, accreditation, mobility and consistency across the states;
• the need for national standards and accreditation of workforce positions;
• the need for one standard of care regardless of who provides the care.

One area of agreement was that the amount of education and training needed for new team members is highly dependent on what the scope of practice and level of supervision would be, and that there would be no one-size-fits-all solution.

When new dental team members are discussed, explained Dr. Hunt, there is a tendency to raise concerns over licensing and certification. He calls this a case of putting the cart before the horse.

“Once there is an understanding of scope of practice鈥攐r what these workforce models will do鈥攖hen the educational community can help to establish competencies, the curriculum needed, and length and type of educational program to achieve these competencies,” said Dr. Hunt.

“I think the meeting was a good first step,” said Dr. Tankersley. “We got the most pertinent things out on the table, reviewed existing models and looked at education and training. We didn’t expect to come to a consensus and we said that from the beginning. It was a dialogue that needed to begin and one that needs to continue. There were areas of agreement, but there are still a lot of unknowns.”

“I think we did a good job of increasing our understanding of the perspectives of our associations and our positions,” said Dr. Hunt.

“I was pleasantly surprised at how willing people were to be open,” Dr. Hunt added. “I think that’s what has to happen. All of our associations have to build a level of trust where there can be differences of opinion. It’s important to be able to talk about a challenging and controversial topic and be able to do it in this type of environment.”