Views of Practicing Dentists Regarding a Mandatory Fifth Year of Training

Abstract

As part of a U.S. Health Resources and Services Administration-funded evaluation of the impact of federal funding on postgraduate general dentistry programs, a random sample of 6,725 dentists graduating in 1989, 1993, and 1997 were surveyed regarding practice patterns, advanced training, populations served, services provided, and their position on a mandatory fifth year of training. Responses (1,965) showed 48 percent supporting a mandatory year and 52 percent not supportive. Open-ended comments were provided by 1,626 respondents. The main reasons for supporting a mandatory fifth year were the need for more instructional time and need for a transition year. Individual choice, no value in a fifth year of dental school, mentoring available elsewhere, and cost were cited in opposition. The following respondents were significantly more likely than other respondents to support a mandatory fifth year: individuals who had completed an AEGD, GPR, or specialty program; were Asian; held salaried positions in a community clinic, nursing home, or hospital; or described themselves as a consultant. Graduates in 1993 and 1997 were less supportive of a mandatory fifth year than were 1989 graduates. Significant differences in the reasons offered in support of respondents' positions on the issue were observed among AEGD, GPR, specialists, and nonspecialists and the three cohort years.

SCDA task force on a special care dentistry residency

“…In particular, many have noted that given the advances in science and technology, the nation's changing demographics, and the rising challenges in caring for vulnerable and underserved populations, the 4‐year undergraduate education is inadequate to fully prepare students not only with sufficient knowledge, but with the skills to integrate this knowledge into practice . Edelstein cites multiple researchers stating that “Evidence suggests that graduates’ perceptions of competency to treat vulnerable people including people with intellectual disabilities, very young children, disabled adults, elders, and frail elders ‐ relates directly to their lack of dental school experiences with these groups.…”

Should PGY‐1 Be Mandatory in Dental Education? Two Viewpoints

“…A survey of 2,018 practicing dentists, published in 2003, found a roughly even split between supporters and non‐supporters of PGY‐1: 48% supported a mandatory year of training, and 52% were opposed 3 . Respondents who had completed an AEGD, GPR, or specialty program were more likely than other respondents to be supporters of PGY‐1, as were those holding positions in a community clinic, nursing home, or hospital clinic.…”

“…Garrison's study reported in 1991 that GPR‐trained practitioners tended to perform more oral surgery, periodontal surgery, complex endodontic procedures, and detailed patient work‐ups than their non‐GPR trained counterparts, while also needing to consult with specialists less frequently 5 . PGY‐1 programs that are hospital‐based also give residents more exposure and experience working with medically complex patients, while expanding residents’ clinical skill sets, knowledge base, and management skills related to emergency care for medically compromised and other patients 3 . In addition, PGY‐1 training makes it possible to tailor experiences based on the individual student's interests and practice goals.…”

“…Thus, many of the educational reasons given in the past for a mandatory PGY‐1 year still apply: the need for more instructional time, both clinical and didactic, particularly as it relates to the use of the innovative dental materials used today, more complex dental techniques, advanced treatment options, and additional experience with evidence‐based treatment planning. Also still needed are experiences that add breadth to the education and skills learned in the predoctoral curriculum 3 , 12 and, consistent with the emphasis on cognitive aspects of dental practice, skills in risk assessment, preventive strategies, and determining outcomes 10 …”

“…As Lefever et al argued in 2003, a required fifth year should not be a continuation of the predoctoral dental curriculum, nor should it be a remediation program 3 . Instead, a mandatory PGY‐1 year would allow greater overall development, stimulate professionalism, and provide more instruction in practice management for the new graduate 5 .…”