ADEA CCI Liaison Ledger

Predictors of Walking on Water

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By Andrew I. Spielman, D.M.D., Ph.D., Professor, New York University College of Dentistry

Every one of us who has something to do with the selection of dental school applicants dreams about students who are smart, educated, ethical, focused, generous, selfless, compassionate, mature, and culturally sensitive, with high social and emotional intelligence, good communication skills, excellent hand-eye coordination, perception ability, a hunger to learn, a healthy dose of self criticism, and the ability to walk on water....

Yeah! Dream on. There is no such person. Reality is that we all have an ideal of what matters in becoming a successful practitioner, and that often means a compromise among all of the above with emphasis on certain metrics. While prior education can be measured by college grades and standardized tests, at best these predict how good a student the candidate may become, not necessarily how good a practitioner. Often the two are not the same. There is evidence that DAT scores and grade point average (GPA) moderately predict how well a student will perform in the first two years in didactic courses. Perception Ability in turn may be used to help predict how well a student will perform in a lab course where hand-eye coordination is important. But what determines a student's ability to be successful, for instance, in a surgical specialty?

In speaking with our Dean, Dr. Charles Bertolami, I received an unexpected answer to this question. Charles read about a study in the early 1980s where GPA, SAT, medical school grades, and other metrics were used to predict career success in a surgical specialty. None of the usual metric predictors held up. Unexpectedly it turned out that prior participation in a team sport was the best predictor.

The specifics may vary from career to career, but these findings raise a larger question. As we seek to identify the next generation of dentists, what qualities should we seek in candidates? In so far as we agree that the long-term solution to increasing access to care lies in diversifying the community of dental practitioners, we must attempt to find new answers. Under represented minority and educationally disadvantaged students are showing that they have the potential to perform as well as their peers in highly competitive dental schools, but first they must get in. Can we look beyond the metrics that predict success in school and ask, what attributes predict success in life?

Perhaps the answer lies in the ability to cope with stress or in having high emotional intelligence. Daniel Goleman, in his excellent book on emotional intelligence, describes the experiments done in the early 1960s by Stanford University psychologist Walter Mischel. These show that delayed gratification is an excellent predictor of later success in life. Mischel, working with preschoolers, used what become known as the marshmallow test. Mischel provided 4- and 5-year old children with a marshmallow and promised them a second one if they postponed eating it for 15 minutes. Children were left alone in the room and videotaped. A decade later, the same children were revisited to appraise their success in school. Mischel concluded:

Children who were able to wait longer at age 4 or 5 became adolescents whose parents rated them as more academically and socially competent, verbally fluent, rational, attentive, ... and able to deal well with frustration and stress.

Part of the difficulty in selecting ideal students for admission to dental school is deciding what combination of qualities one looks at and what emphasis one places on metrics. Should we primarily seek students with the best grades, viewing additional factors as a benefit? Or should we look for acceptable grades with high emotional and social intelligence? It would be ideal to have, along with the outcome of the SAT, college GPA, and DAT, the results of a marshmallow test. In the absence of that, what are the signs of emotional and social intelligence?

Let's start with good eye contact and avoiding pat answers. I often ask applicants to identify one of their weaknesses. Many respond, "I am a perfectionist." Give me a break! Striving for perfection doesn't make one perfect. The inability to critically self-assess one's strengths and weaknesses is a problem that may negatively affect a student's success as a dental student and practitioner.

I look for unusual stories in their lives, for signs of passion, for their "souls." I look for true volunteer work that is not part of a requirement and a sustained activity that started long before the application process. I also ask, "If dentistry did not come with such financial rewards, would you still apply to dental school?" and watch for the B.S. in their reply. I often wonder why so very few admit that the main reason they apply to dental school is to have a secure life with a good income. Instead, many become fascinated with dentistry "ever since my kid sister got braces," or they "like to work with their hands" or "helping people." If they like working with their hands, how come so few apply to become a watchmaker, or if they like to help people, how come so few dental applicants apply to be nursing students? Haven't they noticed that there is a shortage of nurses, and the tuition is substantially less?

What I am looking for in these answers is a sign of honesty in the face of potentially not being accepted. For all the obvious reasons, honesty is essential to being a trusted member of the student body and of the profession, and doing the right thing for the patient and only for the patient. We often forget that practicing dentistry is a privilege, not a right. Society entrusts us to do the right thing for patients to the best of our ability, and this also implies that beyond graduation we will continue to learn the latest and the most appropriate treatment modalities, critically evaluate information in the best interest of our patients, and live up to the trust with which society and our patients endow us.

Sometimes, no treatment is the best treatment. I remember my former surgery professor who taught us that "a good surgeon becomes great when s/he knows when not to operate." Would a practitioner give up invasive treatment (and potential income) if s/he were faced with the prospect that no treatment would be the best option for the patient? In my book, when a practitioner resolves such a financial conflict of interest in the patient's favor, s/he has passed with flying colors the test of being a successful practitioner. I truly believe honesty is the single most important predictor of a successful practitioner, and we can try to identify this characteristic at the outset.

A second characteristic that is equally critical is a student's ability to communicate with patients. This means relating to their suffering, feeling the urgency the patients feel, and dedicating the attention to their patients that they deserve. In other words, having the social and emotional intelligence and skills to relate to patients, to be empathetic, to be compassionate, to have a "soul."

In a modern and diverse society like ours, with its changing demographics, this ability is entwined with a level of cultural competency that is best fostered by having a diverse population of students. This exposure to people from a broad range of backgrounds helps create future practitioners who can identify with their patients, feel their pain, and make them feel comfortable.

I am convinced that we are getting a group of smart and ambitious students at the dawn of their careers. The key is to discern the above two characteristics before admission and not be blindsided by the shining metrics students bring to the table. Those metrics tell us something about a student's potential for success during the first few years of dental school. However, the other, "non-metric" characteristics are even more important for succeeding in life.

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