A graduate student’s, graduate program director’s, and chairman% perspective of the Dentist Scientist Award program

David A. Felton, DDS, MSa University of North Carolina, School of Dentistry, Chapel Hill, N.C.

The Dentist Scientist Award (DSA) program was introduced as an innovative mecha- nism of support and structure to meet the critical demand for the training of expert clinician scientists. This article presents an overview of the University of North Carolina’s DSA program as it relates to the Department of Prosthodontics and the graduate program in prosthodontics. Recruitment of DSA candidates for the program and for faculty positions is described. (J PROSTHET DENT 1996;75:671-4.)

T he recently published Institute of Medicine study’ entitled “Dental education at the crossroads: challenges and change” suggests that each dental school achieve the following:

1.

2.

3.

4.

5.

The schools support a research program that includes clinical research, evaluation, and dissemination of new scientific and clinical findings, research on outcomes, health services, and behavior related to oral health; The schools extend their research programs to the ba- sic sciences and to the transformation of new scientific knowledge into clinically useful applications; The schools meet or exceed the standards for research and scholarship expected by their parent universities or academic health centers; The schools should expect all faculty to be critically knowledgeable about scientific advances in their fields and to stay current in their teaching and practices; and The schools should encourage all faculty to participate in research and scholarship.

The key objectives to advancing these goals are to estab- lish research as a priority, secure new funding sources and redistribute existing resources, develop creative strategies to extend the scope of oral health research, attract quali- fied new people and develop existing faculty, and sustain this capacity over time.

A recent committee of the National Research Council’s Office of Scientific and Engineering Personnel cited an alarming shortage of trained researchers in oral health and indicated that at least 200 graduates per year (which is four times the number currently trained) were needed to supply the needs of the dental schools. The committee also recommended that half of a dental school’s faculty should be clinical scholars and the other half should be scholarly clinicians.2 In addition, the American Dental Association’s Committee on Dental Accreditation has developed accred- itation standards for research. These standards include the following:

Presented before the Academy ofProsthodontics, Tucson, Arizona, May 1995.

“Chairman, Department of Prosthodontics.

Table I. Current prosthodontic DSA fellows in training

Research Anticipated DSA Fellow PKQ-ZlItl mentor completion

Dr. Hollis Heinzerling Rochester Burne 1995 Dr. Rebecca Elovic Harvard Hayes 1995 Dr. Lance Ramp UAB Lucas 1996 Dr. Benjamin Wu Harvard Riley 1997 Dr. Lonnett Phipps UAB Russell 1997 Dr. Galen Schneider UNC Burridge 1996 Dr. Deborah Rigsby UAB Lucas 1997 Dr. Dara Barron Rochester Ballatori 1998 Dr. Daniel Givan UAB Lemons 1998 Dr. Michael McCracken UAB Lucas 1998

UAB, University of Alabama at Birmingham; UNC, University of North Carolina.

Research must be an integral component of the mission of each dental educational institution. A formal research development plan must be evident to ensure the continual support of the research mission of the institution. The amount of time and resources available for faculty research should be sufficient to support the objectives of the institution.

The institutional and individual Dentist Scientist Award (DSA) programs introduced an innovative mechanism of support and structure to meet this critical demand for the training of expert clinician scientists. Because the gradu- ates from DSA programs on the national level are still early in their careers, it is not fully possible to definitively assess the degree to which the DSA program is achieving its goals. To the extent that it can be evaluated, it appears that the program has provided an important influx of ex- tremely bright, well-trained, and productive young scien- tists to the dental education/research setting. Table I lists those DSA Fellows who are “in training” in prosthodontics, the location of their training facilities, and their tentative completion dates from the DSA programs.

The DSA program at the University of North Carolina School of Dentistry has been a strong participant in this effort and has contributed outstanding young clinician- scientists to a variety of institutions after they have com-

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pleted their programs. This DSA program offers a broad spectrum of high-quality clinical and research training op- portunities. The original approach and organization of the program have proved to be effective and have been modi- fied and improved through 9 years of experience.

The purpose of this article is to describe the University of North Carolina’s DSA program experience, particularly as it relates to both the graduate program in prosthodon- tics and the Department of Prosthodontics.

OVERVIEW OF THE DSA PROGRAM

The DSA program at the University of North Carolina was funded without advance notice in September 1985. The administrative structure of the program was immedi- ately implemented, which included the appointment of the DSA Advisory Board, which serves to select Fellows for the program and to review the program content and direction. In spite of the off-cycle funding date, two excellent Fellows were selected from enrolled first-year residents in the var- ious specialty programs, and they entered the program on November 1, 1985, a mere 7 weeks after notification of funding. The DSA program usually involves 5 or more years and results in completion of a PhD degree in a basic science area and concomitant completion of a certificate program in an advanced dental specialty program.

Since its inception the University of North Carolina DSA program has selected Fellows in a structured fashion. Re- cruitment begins in January of each year and extends un- til November 1, when the candidates are notified for entry into the next class, which commences July 1 of the follow- ing year. Program announcements are sent to all dental schools and institutions where potential candidates can be identified. Special emphasis is placed on predominately minority institutions. Candidates applying for the pro- gram are invited to the Chapel Hill campus to evaluate the program for their purposes and to allow the graduate pro- gram director of the dental specialty and selected depart- mental faculty to interview the candidates for suitable ad- mission into the specialty program. The deadline for applications and completion of the initial visits is October 1 of each year. From the pool of candidates who apply, make visits, and are clearly competitive, those selected are invited for interviews with the DSA Advisory Board and program directors. After a series of 30-minute interviews, the Advisory Board selects the candidate(s) for the follow- ing year. Before 1994 two Fellows were selected annually for the DSA program; currently, one per year is selected. Typically, 20 or more inquiries are received, which results in 7 to 18 qualified applications. From that pool 3 to 7 Ii- nalists are interviewed for the one (formerly two) posi- tion(s) available. Of 18 selections made during the Univer- sity of North Carolina’s involvement in the DSA program, all but two of the first choices elected to enroll in the pro- gram. Unfortunately, the two candidates who elected not

to accept the DSA program offer were prosthodontic can- didates.

ANALYSIS OF THE B-YEAR TRAINING PROGRAM

Generally, the clinical training in the dental specialty and the research training aspects of the program have fol- lowed these flexible guidelines. During the various years of the program the Fellow’s efforts are divided as follows.

During the first year, 80% of the Fellow’s time is directed toward basic science course work-laboratory rotations and 20% is directed toward clinical training. Emphasis is placed on completion of most, if not all, of the course requirements for their respective PhD programs. The Fel- lows typically take three research laboratory rotations in laboratories that are of potential interest to them as envi- ronments where their dissertation research will be con- ducted. It is intended that a laboratory mentor in the ba- sic sciences for the PhD dissertation project will be selected by the end of this year.

During the second year, the reverse of the first year’s time commitments occurs, with 80% of the Fellow’s time being spent in clinical training in the dental specialty area and 20% in basic science laboratory rotations. Even with the demands of the clinical residency training, the Fellows have been surprisingly active and productive in the re- search area during the second year. The Fellows are excused from those courses in research methods, biosta- tistics, and scientific writing present in the graduate pro- gram in the clinical disciplines because these courses are covered within the confines of the PhD program (generally in the first year). This provides additional research time during the second year.

During the third year, an equal time sharing occurs, with 50% effort directed toward the basic science research and 50% toward continuation of the dental specialty clin- ical training. Careful planning is required to equitably split the Fellow’s time commitments during the third year, which is an extremely demanding period. Substantial progress is made in the clinical training program. In the research discipline, any remaining course work is finished, the dissertation project is defined, and work on the project is initiated.

During the fourth year, the emphasis is returned to ba- sic science training, where 70% effort is directed toward basic science research and 30% is directed toward clinical training. The 70% time commitment is directed almost ex- clusively toward the dissertation project. It is expected that substantial progress on the project be achieved dur- ing this year. Most of the residency requirements of the clinical discipline are completed during this year.

During the fifth year, 80% of the Fellow’s effort is directed toward basic science research and 20% is directed toward clinical training. The objective of the fifth year is to

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successfully defend the dissertation by the end of the year or shortly thereafter. The clinical activities are used to complete patients and maintain clinical skills.

SELECTION OF MENTORS

On entering the University of North Carolina DSA pro- gram, the program directors of the clinical residency and the PhD level research training program serve as comen- tors until the PhD dissertation mentor is identified (usu- ally at the end of the first year or early in the second year). This comentorship arrangement provides the input re- quired for careful planning of the critical, initial stages of the respective programs in a coordinated fashion. Once the PhD dissertation project mentor is selected, he or she be- comes the primary mentor. The graduate program direc- tors continue to be involved to ensure that the require- ments of the respective clinical programs are met.

Selection of the dissertation project mentor is the most important decision in each Fellow’s program. Selection of a PhD mentor must be approved by the clinical depart- ment, the basic science department, and the director of the university DSA program. It should be based on mutual re- spect for the value, importance, and integrity of each aspect of the DSA program. Each program is custom designed for the Fellow and is agreed upon by both the re- search (PhD) mentor and the graduate program director. Meetings of the Fellow, his research mentor, and his pro- gram director are held at least annually to determine the course of study for the following year.

Completion of a clinical residency and the PhD degree in basic research in 5 years seemed, at the outset, to be an unrealistic goal, particularly when compared with those graduates who pursue only a basic science PhD degree at the University of North Carolina, which typically con- sumes 7 years of effort. However, the intense motivation and remarkable talents of the DSA Fellows, along with careful planning of their programs, has allowed a few of them to achieve these goals in 5 years. Most require an ad- ditional 6 months to complete the dissertation. With one exception, all the University of North Carolina DSA Fellows have finished during the sixth year. Unfortu- nately, funding for the Fellows ends at the completion of the &year period. Individual universities are responsible for funding if the training exceeds 60 months. The impact of conversion of all prosthodontics residency programs from 24 to 30 or 36 months has not been fully weighed on the existing DSA programs. At the University of North Carolina, whose 36-month residency program has existed for 8 years, the impact has been negligible.

DEMOGRAPHIC PROFILE OF THE DSA FELLOWS

The demographic profile of the 18 Fellows originally en- rolled at the University of North Carolina is as follows. The

Table II. Prosthodontists trained in the DSA program

Faculty Training Program

current YEtI- Position

Dr. Lyndon F. Rochester/ Cooper Eastman

Dr. Brien O’Connell Rochester/ Eastman

Dr. Karen Richter- Iowa Snam

Dr. Clark Stanford Iowa Dr. Mira Edger-ton SUNY/Buffalo

Dr. Kirby Bodden LJAB/ Birmingham

Dr. Anthony UMDNJ Iacoppino

Dr. Amy Ridall U Texas/Houston

1990 UNC

1993 NIDR

1990 Northwestern

1992 Iowa 1993 SUNY/

Buffalo 1994 uAB/

Birmingham 1991 Baylor

1993 U Texas/ Houston

UNC, University of North Carolina; NIDR, National Institute of Dental Research; SUNY, State University of New York; UAB. University of Ala- bama at Birmingham; UMDNJ, University of Medicine and Dentistry of New Jersey; U Texas, University of Texas.

program has trained 11 men and 7 women, of whom 13 are white, 3 are black, 1 is Hispanic, and 1 is Asian. Only 4 of those enrolled have discontinued the program. Three of the vacancies were filled with outstanding replacements who were at the appropriate stage in similar programs.

The majority have been trained through the Department of Orthodontics as their clinical specialty area, followed by Pediatric Dentistry and Periodontics, Oral and Maxillofa- cial Surgery, and the remainder in what will collectively be called “the other” specialties.

Of the seven DSA Fellows who have completed the pro- gram, four are in full-time, research-oriented faculty posi- tions; two are in postdoctoral training fellowships in outstanding laboratories; and another is in a full-time re- search position with a pharmaceutical company. Two postdoctoral Fellows will complete their fellowships in June 1995 and are being heavily recruited by several institutions for faculty positions. The university DSA Ad- visory Board feels strongly that a postdoctoral fellowship is an extremely desirable next step after completion of the program. Comparing the publication and grants record of those completing the DSA program with other university- trained PhD candidates has pointed out two important considerations. First, it is extremely desirable for the Fel- lows completing the PhD program to receive good postdoc- toral experience, either in a postdoctoral fellowship or in an initial faculty position that, in effect, offers the protected and supportive environment of a postdoctoral position. The latter opportunity is rare and is often viewed unfavorably by grant-funding agencies. University wide, nearly all nonclinical PhD recipients complete one or two postdoc- toral fellowships. It is unrealistic to expect the DSA grad-

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uates to compete successfully for available research dollars with that group without a similar level of training and ex- perience. The goals of a postdoctoral experience should be to immerse an individual in a focused area of research so that he or she can emerge with the capability of submitting a competitive grant in a committed area of interest.

Second, the initial faculty appointment must be at an institution and in a setting where attitudes are supportive and where fiscal and human resources are adequate to nurture and mentor the beginning investigator. A major emphasis of the University of North Carolina DSA pro- gram is to place graduates in environments where their development as clinician-scientists can appropriately con- tinue.

One unique feature of the University of North Carolina program is the establishment of an oral biology PhD pro- gram within the Dental Research Center. During the g-year course of the DSA program, there have been several potential candidates that did not pursue training because of the lack of availability of an oral biology PhD program that could provide an oral focus to the basic sciences. An oral biology PhD program has now been established on the basis of the considerable expertise of the university’s research faculty. This program offers tracks in three sub- disciplines of oral biology reflecting the research interests of the involved faculty: oral neurobiology, host-microbial interactions, and extracellular matrices.

The University of North Carolina DSA program is eval- uated continuously by the program director, Dr. Roland Arnold, by the Fellows, by the research mentors and grad- uate program directors, and by the DSA Advisory Board. Definitive evaluation of the program must await review of the graduates’ progress and contributions as clinician-sci- entists as their careers advance. Each DSA Fellow holds assistant professor status within the University and re- ceives university benefits during the course of training.

FUTURE DIRECTIONS

The heart of any university’s research mission is the discovery of new knowledge and the dissemination and in- tegration of this knowledge through predoctoral, graduate, and continuing education programs. Unfortunately, many dental school faculty lack the training necessary to be competitive for the shrinking research dollar. The Dentist Scientist Award Program provides the opportunity to train talented young investigators who are capable of bringing “cutting edge” science to academic dentistry. To be suc- cessful, the school must provide the DSA-trained faculty with the support necessary to be successful. This support includes (1) adequate research space, (2) start-up funds to

purchase equipment and supplies necessary to properly outfit a laboratory and to hire laboratory technicians, and (3) senior mentors. The recently hired DSAFellow who has just completed a postdoctoral training fellowship is not a seasoned researcher or grantsman; he must be properly mentored in a nurturing environment that will provide those additional skills that will, ultimately, allow him or her to be successful. Dental school deans are often willing to throw money into equipment and supplies but may ig- nore those more important areas of support that can make the young clinician-scientists successful or hinder their development.

Of the nearly 250 individuals who have completed the DSA program or who are currently in training in the pro- gram, fewer than 8% are clinically trained (or in training programs) in prosthodontics. Table II lists those prosth- odontists who have completed their PhD training through the DSA program, along with their current academic affil- iations. The specialty enjoys a low “drop out” rate from the DSA program, with only one Fellow leaving the program to enter private practice.

The specialty of prosthodontics must accept the chal- lenge to support the recruitment and training of faculty capable of conducting “cutting edge” research in an aca- demic environment. This must begin at the predoctoral level by instilling a keen interest in the specialty of pros- thodontics and by fostering a collegial atmosphere that blends critical thinking, excellent science, and evidence- based dentistry. Only then can the specialty hope to attract the best and the brightest into prosthodontics-based DSA programs. I challenge the members of the Academy of Prosthodontics and the American College of Prosthodon- tists to begin to identify those talented predoctoral stu- dents early in their dental school careers and to begin fos- tering relationships that will stimulate a keen interest in both the basic sciences and the specialty of prosthodontics.

REFERENCES

1. Feld MJ, editor. Dental education at the crossroads: challenges and changes. Committee on the Future of Dental Education, Division of Health Care Services. Washington, DC: National Academy Press, 1995.

2. Report of the Committee on Biomedical and Behavioral Research Per- sonnel. Washington, DC: National Academy Press, 1989.

Reprint requests to: DR. DAVID A. FELTON DEPARTMENT OF PROSTHODONTICS UNIVERSITY OF NORTH CAROLINA SCHOOL OF DENTISTRY ROOM 302, BRAUER HALL CB# 7450 CHAPELHILL,NC 27599-7450

Copyright 0 1996 by The Editorial Council of THE JOURNAL OF PROSTHETIC DENTISTRY.

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